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Transabdominal manually assisted reduction of pediatric intussusception: reappraisal of this historical technique
S N Grasso1, M E Katz, H J Presberg
1Department of Radiology, Children's Hospital of the King's Daughters, Norfolk, Va.
Insights
Manual abdominal manipulation during intussusception reduction significantly improves success rates. This technique, when used after initial pneumostatic pressure failure, increased success from 58% to 76% without complications.
Area of Science:
- Pediatric Surgery
- Gastroenterology
Background:
- Intussusception is a common surgical emergency in children.
- Pneumostatic pressure reduction is a standard treatment, but success rates vary.
- The role of manual manipulation in reduction has been historically debated.
Purpose of the Study:
- To evaluate the efficacy of transabdominal manual manipulation in improving intussusception reduction success rates.
- To assess whether manual manipulation impacts patient morbidity.
Main Methods:
- Retrospective analysis of 38 intussusception cases in 35 children.
- Initial treatment involved pneumostatic pressure reduction.
- Transabdominal manual manipulation was employed when initial reduction failed.
- A literature review on intussusception reduction was conducted.
Main Results:
- Pneumostatic pressure alone achieved a 58% success rate (22/38 cases).
- Manual manipulation was used in 10 cases with initial failure, resulting in 7 additional successful reductions.
- The overall success rate increased significantly to 76% with manual assistance (P < .016).
- No complications, such as perforation, were observed.
Conclusions:
- Transabdominal manual assistance is a safe and effective adjunct to pneumostatic pressure for intussusception reduction.
- The historical avoidance of manual manipulation lacks scientific justification.
- This technique offers a valuable option to improve intussusception treatment outcomes.
Purpose:
To determine whether manual manipulation of the abdomen during intussusception reduction improves the success rate or affects morbidity.
Materials And Methods:
A retrospective study was performed in 38 cases of intussusception in 35 children over a 33-month period at a pediatric hospital. In all cases, pneumostatic pressure was used as the initial method of treatment. A comparative review of the intussusception literature was also performed.
Results:
Reduction was achieved with pneumostatic pressure alone in 22 cases (an initial success rate of 58%). Transabdominal manual manipulation was used in 10 cases after initial pneumostatic reduction failed; seven of these 10 cases were treated successfully. These seven additional successes, attributed to manual assistance, significantly improved the success rate from 58% to 76% (P < .016). No perforation or other complication occurred.
Conclusion:
These results and findings of the literature review indicate that transabdominal manual assistance during reduction is a potentially useful technique that has been shunned without scientific basis for longer than 40 years.