Determinants of ultrasound-guided reduction failure and pathological lead points in pediatric intussusception
Yannick Braun1, Henning C Fiegel1, Udo Rolle1
1Department of Pediatric Surgery and Pediatric Urology, Goethe University Frankfurt, University Medicine, Frankfurt, Germany.
Insights
Ultrasound-guided hydrostatic saline enema (USGSE) is effective for pediatric intussusception. Prolonged symptoms and bloody stools predict USGSE failure, which strongly suggests a pathological lead point requiring surgical evaluation.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Radiology
Background:
- Intussusception is a primary cause of bowel obstruction in children.
- Ultrasound-guided hydrostatic saline enema (USGSE) is the standard non-surgical treatment.
- Predictors of USGSE failure and pathological lead points (PLPs) require further definition.
Purpose of the Study:
- To identify predictors of USGSE reduction failure in pediatric ileocolic intussusception.
- To determine factors associated with pathological lead points (PLPs).
Main Methods:
- Retrospective review of pediatric patients (<18 years) with ileocolic intussusception from 2012-2022.
- Analysis of clinical variables including symptom duration, vomiting, bloody stools, and age.
- Logistic regression models to identify predictors of USGSE failure and PLPs.
Main Results:
- USGSE success rate was 76.92% overall.
- Symptom duration >24 hours, bloody stools, and younger age predicted USGSE failure.
- Failed USGSE was a strong predictor of PLPs (OR 107.26), with Meckel's diverticulum being the most common.
Conclusions:
- USGSE is a safe and effective treatment for pediatric ileocolic intussusception.
- Prolonged symptoms and bloody stools indicate higher risk of reduction failure.
- Failed USGSE necessitates prompt evaluation for underlying PLPs and potential surgical intervention.
Purpose:
Intussusception is a leading cause of acute intestinal obstruction in children. Ultrasound-guided hydrostatic saline enema (USGSE) is widely accepted as first-line non-surgical management, but predictors of reduction failure and pathological lead points (PLPs) are not well defined.
Methods:
We retrospectively reviewed pediatric patients (< 18 years) with ileocolic intussusception treated between 2012 and 2022. Clinical variables included symptom duration, vomiting, bloody stools, and age. Univariable and multivariable logistic regression analyses were used to identify predictors of failed USGSE and PLPs.
Results:
Eighty-nine patients (93 episodes) were analyzed; 97.85% underwent USGSE as initial treatment. Overall reduction success was 76.92% (70/91) and 90.28% (65/72) in patients without PLPs, with no complications. Symptom duration > 24 h was associated with failed USGSE (OR 4.29, p = 0.0052). After excluding PLP cases, predictors of failure included symptom duration > 24 h (OR 13.97, p = 0.0059), bloody stools (OR 6.83, p = 0.0245), and younger age (p = 0.0094). PLPs were identified in 18 patients (20.2%), most commonly Meckel's diverticulum. Failed USGSE was the sole independent predictor of a PLP (OR 107.26, p < 0.0001).
Conclusion:
USGSE is safe and highly effective for pediatric ileocolic intussusception. Prolonged symptoms and bloody stools predict reduction failure, while failed USGSE strongly indicates an underlying PLP, supporting prompt intervention and surgical evaluation when reduction is unsuccessful.
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