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A Technique to Reduce the Early Recurrence of Intussusception in Ultrasound-Guided Hydrostatic Reduction
Feng Yu1, Huanhua Chen1, Xiaoqing Cao1
1Department of Ultrasound Diagnostics, Dongguan Eighth People's Hospital, Dongguan, Guangdong, China.
Insights
Maintaining intestinal pressure for 15 minutes after ultrasound-guided saline enema may reduce early intussusception recurrence in children. This simple modification to the procedure shows promise in preventing repeat intussusception events within 48 hours.
Area of Science:
- Pediatric Gastroenterology
- Medical Imaging
- Surgical Procedures
Background:
- Intussusception is a common surgical emergency in children.
- Ultrasound-guided saline enema is a primary treatment for pediatric intussusception.
- Early recurrence of intussusception after reduction is a known complication.
Purpose of the Study:
- To investigate methods for reducing early recurrence of pediatric intussusception.
- To evaluate the impact of maintaining intestinal pressure after saline enema on recurrence rates.
- To compare early recurrence rates between immediate and delayed fluid drainage after enema.
Main Methods:
- A retrospective study of pediatric patients (0-14 years) with ileocolic intussusception.
- Comparison of two groups: immediate fluid drainage (control) vs. 15-minute pressure maintenance (intervention).
- All patients received successful ultrasound-guided saline enema reduction.
Main Results:
- The intervention group (15-minute pressure maintenance) showed a numerically lower early recurrence rate (10%) compared to the control group (19%).
- No significant difference in the number of recurrences per person was observed between the groups.
- Factors associated with lower recurrence included older age, shorter enema duration, and lower enema pressure.
Conclusions:
- Maintaining reduction pressure for 15 minutes post-enema may decrease early intussusception recurrence.
- Further randomized controlled trials are recommended due to potential incomparability of study cohorts.
- The findings suggest a potential refinement to the ultrasound-guided saline enema procedure.
Objectives:
Ultrasound-guided saline enema is highly successful in treating pediatric intussusception; however, early recurrence-within 48 hours-is possible. This study aimed to explore effective methods of reducing early recurrence.
Methods:
This study included patients aged 0 to 14 years diagnosed with ileocolic intussusception with a symptom duration of <48 hours from January 2019 to March 2021. The patients were divided into control and intervention groups. All patients received successful treatment with ultrasound-guided saline enema; however, in patients treated before January 4, 2020 (control group), the intestinal fluid was drained immediately, and in patients treated after January 4, 2020 (intervention group), the intestinal fluid was drained after 15 minutes of intestinal pressure maintenance. Early recurrence rates of the groups were compared.
Results:
Ileocolic intussusception was treated successfully by ultrasound-guided saline enema in 231 patients (116, control group;115, intervention group). The early recurrence rate in the intervention group (10%; 95% CI: 4.9-16.5) was numerically lower than that in the control group (19%; 95% CI: 12.3-27.3). No significant difference was observed in the number of recurrences per person between the groups (P = .448). Patients without early recurrence were older (P = .004) and received enemas of a shorter duration (P < .001) and lower pressure (P < .001) than patients without early recurrence.
Conclusions:
Maintaining reduction pressure for 15 minutes after a successful ultrasound-guided saline enema may reduce the early recurrence of intussusception. A randomized controlled trial is needed because the intervention and control cohorts were most probably incomparable (due to the COVID-19 pandemic).
