Repeated ultrasound-guided hydrostatic reduction for pediatric intussusception: attempt number, interval, and success

To investigate the effects of the number of attempts, the interval between attempts, and their interaction with sonographic features on the ultimate success rate of repeated ultrasound-guided hydrostatic reduction (UGHR) in pediatric intussusception, and to determine the reasonable upper limit for the number of attempts and the optimal interval time.

This multicenter retrospective cohort study included children admitted to four large pediatric medical centers between January 2020 and December 2024 who received at least one repeated UGHR attempt after initial failure. Detailed clinical, sonographic, and procedural data from multiple reduction attempts were collected. The relationships between interval time, number of repeated attempts, and the success rate were analyzed.

Among 318 children, the cumulative non-operative success rate was 78.9%. Success declined steeply beyond the third attempt (69.8% for the second, 57.7% for the third, 20.0% for the fourth). A ≤ 60-min interval and improving sonographic bowel-wall thickness and vascularity independently favored reduction.

For children who fail initial UGHR, actively pursuing a second attempt is recommended if vital signs are stable, and the interval should ideally not exceed 60 min. Limiting the total number of non-operative reduction attempts to three is reasonable. Sonographic monitoring for improvements in bowel wall edema and blood flow provides crucial guidance for deciding whether to continue attempts.