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Updated: Aug 23, 2026
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Published on: April 7, 2023
Effectiveness of ultrasound-guided hydrostatic versus fluoroscopy-guided air reduction for pediatric intussusception:
1Department of Pediatric Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt. a.abdelmohsen@azhar.edu.eg.
Background:
The comparative effectiveness of fluoroscopy-guided air reduction (FGAR) versus ultrasound-guided hydrostatic reduction (UGHR) for pediatric intussusception remains uncertain, especially when clinical and sonographic severity are considered.
Objective:
To compare the effectiveness and safety of FGAR and UGHR after adjusting for disease severity and to identify independent predictors of non-operative reduction failure.
Methods:
A retrospective cohort of 192 children (0-24 months) with ileocolic intussusception treated between 2018 and 2024 was analyzed. Baseline clinical variables and ultrasound markers were collected. Multivariable logistic regression, adjusting for clinical and sonographic severity markers (symptom duration, anal protruding mass, intussusceptum length, and trapped fluid), identified predictors of failure, with model performance assessed using the area under the ROC curve.
Results:
Children undergoing UGHR presented with more severe disease, including longer symptom duration (34 vs. 22 h; p = 0.01), higher delayed presentation > 48 h (32.1% vs. 15.0%; p = 0.004), and more trapped fluid (30.4% vs. 16.3%; p = 0.02). Initial success was 86.3% for FGAR and 77.7% for UGHR (p = 0.12); however, the UGHR group had significantly more trapped fluid and longer symptom duration at baseline. After adjustment for these and other severity markers, technique was not associated with failure (aOR 1.22, 95% CI 0.64-2.28; p = 0.54). Independent predictors included longer symptom duration (aOR 1.27 per 12 h; p < 0.001), anal protruding mass (aOR 3.58; p = 0.01), greater intussusceptum length (aOR 1.41 per cm; p < 0.001), and trapped fluid (aOR 3.47; p < 0.001). Model discrimination was excellent (AUC 0.85). Perforation rates were similarly low (1.3% FGAR vs. 0.9% UGHR).
Conclusion:
After adjusting for disease severity, UGHR and FGAR show equivalent effectiveness and safety. Crude differences reflect more severe presentations in the UGHR group. Severity markers-including symptom duration, trapped fluid, and intussusceptum length-are strong predictors of failure and should guide clinical decision-making.