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Pneumatic reduction of intussusception: clinical experience and factors affecting outcome
V G McDermott1, T Taylor, S Mackenzie
1Department of Diagnostic Radiology, Royal Hospital for Sick Children, Edinburgh.
Insights
Pneumatic reduction for intussusception is highly successful (74%) with few complications. Early intervention improves outcomes, while prolonged symptoms or rectal bleeding may indicate failed reduction.
Area of Science:
- Pediatric Surgery
- Gastroenterology
Background:
- Intussusception is a common surgical emergency in infants and children.
- Pneumatic reduction is a primary non-operative treatment method.
Purpose of the Study:
- To evaluate the success rate of pneumatic reduction for intussusception.
- To identify factors influencing the success or failure of this procedure.
Main Methods:
- Retrospective review of 62 pneumatic reduction attempts in 54 pediatric patients.
- Analysis of patient demographics, symptom duration, clinical presentation, and surgical findings.
Main Results:
- Successful reduction was achieved in 74% of cases (46/62).
- Factors associated with failed reduction included prolonged symptoms, rectal bleeding, and small bowel obstruction.
- Complications included one perforation and four early recurrences (7%).
- Lead points (Meckel's diverticulum, pinworm) were identified in three cases requiring resection.
Conclusions:
- Pneumatic reduction is a safe and effective treatment for intussusception with a high success rate.
- Earlier diagnosis and intervention are recommended to increase the likelihood of successful pneumatic reduction.
Abstract:
Between 1987 and 1992, 54 patients (32 male, 22 female) underwent 62 attempts at pneumatic reduction of intussusception. The mean age at presentation was 12.5 months (range 2.5 to 4 years 4 months). A retrospective review of all cases was performed to identify success rate and factors affecting it. Successful reduction was achieved in 46 cases (74%). One case was complicated by perforation and four cases (7%) by early recurrence. Patients with failed pneumatic reduction were more likely than those with successful reduction to have: (1) long duration of symptoms; (2) bleeding per rectum; (3) small bowel obstruction. Among the 16 cases of failed reduction, surgical findings were: five cases of ileo-ileo-colic intussusception, one with ileo-ileal, one with perforated ischaemic colon during air enema and one whose intussusception was found to be reduced at surgery. Three patients had lead points: Meckel's diverticula in two and a pinworm in one. Resection was required in three cases for non-viable bowel and in another two for the Meckel's diverticula. Pneumatic reduction of intussusception offers a high success rate with few complications. Performing an air enema earlier in the course of the disease may increase the chance of successful reduction.