A Study of Predictors of Failure of Nonoperative Management of Ileocolic Intussusception in Children
Jibreel Y Shah1, Imad Banday1, Hanna Z Hamdani2
1Department of General and Minimal Invasive Surgery, Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, India.
Insights
Nonoperative management of intussusception is successful in 85.5% of pediatric cases. Predictors of failure include abnormal lab results and specific imaging findings, guiding treatment decisions for intussusception.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Medical Imaging
Background:
- Intussusception management varies globally, with developing nations relying on surgery and high resection rates.
- Nonoperative reduction is preferred in high-income countries, necessitating identification of predictive factors for success.
Purpose of the Study:
- To investigate the clinical characteristics of pediatric intussusception patients.
- To identify clinical and radiological predictors of successful or failed nonoperative management.
Main Methods:
- Prospective study of 118 pediatric patients with intussusception over 3 years.
- Management involved either hydrostatic reduction or surgical intervention.
- Analysis of clinical symptoms, laboratory parameters, and imaging findings (X-ray, Ultrasound).
Main Results:
- Majority of patients were male (65.5%), mean age 13.54 months.
- Overall hydrostatic reduction success rate was 85.5%.
- Key predictors of failure included elevated TLC, CRP, lactate levels, air-fluid levels on X-ray, bowel wall edema, aperistalsis, and pathological lead points on ultrasound.
Conclusions:
- Hydrostatic reduction is a safe and effective treatment for intussusception when indicated.
- Continuous pain, irritability, tenderness, deranged lab parameters, and specific imaging findings predict lower success rates for nonoperative management.
Background:
Surgery remains the mainstay in treating intussusception in developing nations. A correspondingly high bowel resection rate exists despite a shift to nonoperative reduction in high-income countries. We aimed to study the clinical profile of the patients with intussusception presenting to our hospital and to assess the clinical and radiological predictors of success or failure of nonoperative management of intussusception.
Materials And Methods:
This prospective study was conducted in the Department of Pediatric Surgery over a period of 3 years and included a total of 118 patients who presenting to our emergency division with features suggestive of intussusception and were managed accordingly either with hydrostatic reduction or by surgical intervention.
Results:
We observed that the majority of the patients were males (65.5%). The mean age was 13.54 months. Intermittent pain was the most common symptom. Both pain and vomiting did not affect the outcome. Lab parameters like raised total leukocyte counts (TLC), C-reactive protein (CRP) and lactate levels were significantly associated with failure of hydrostatic reduction. Patients with air fluid levels on X-ray were more likely to end up in surgery. Ultrasound findings of bowel wall edema, aperistaltic gut loops and a pathological lead point was associated with failure of hydrostatic reduction as well. The overall success rate of hydrostatic reduction was 85.5%.
Conclusion:
Hydrostatic reduction of intussusception is a safe and effective method of management of intussusception whenever indicated. Factors that might reduce the chance of its success include continuous pain, irritability, tenderness, deranged lab parameters like TLC, CRP and lactate levels, air fluid levels on X-ray, bowel wall edema, aperistalsis and the presence of a lead point.
How To Cite This Article:
Shah JY, Banday I, Hamdani HZ, et al. A Study of Predictors of Failure of Nonoperative Management of Ileocolic Intussusception in Children. Euroasian J Hepato-Gastroenterol 2024;14(1):81-85.
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