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Childhood intussusception: ultrasound-guided Hartmann's solution hydrostatic reduction or barium enema reduction?
1Department of Surgery, University of Hong Kong, Queen Mary Hospital, Hong Kong.
Insights
Ultrasound-guided hydrostatic reduction using Hartmann's solution is a safer and more effective treatment for childhood intussusception than barium enema reduction. This method offers a higher success rate and avoids radiation exposure.
Area of Science:
- Pediatric Surgery
- Medical Imaging
- Gastroenterology
Background:
- Intussusception is a common surgical emergency in children.
- Traditional reduction methods like barium enema carry risks such as radiation exposure.
Purpose of the Study:
- To compare the efficacy of ultrasound-guided hydrostatic reduction with barium enema reduction for childhood intussusception.
- To evaluate success rates, recurrence, and complications associated with each method.
Main Methods:
- Ultrasound-guided reduction used Hartmann's solution at 100 mm Hg pressure.
- Barium enema reduction was performed under fluoroscopy.
- Exclusion criteria included age >12 years, shock, peritonitis, perforation, distension, and >3 recurrences.
Main Results:
- Ultrasound-guided reduction achieved a 91% success rate for ileocolic intussusception compared to 55% for barium enema (P = .00865).
- Ultrasound group: 11.5% recurrence, 4.4% lead point. Barium enema group: 4.2% recurrence, 4.4% lead point.
- Both methods had 100% accuracy in diagnosing complete reduction and no complications.
Conclusions:
- Ultrasound-guided hydrostatic reduction is a preferred method for childhood ileocolic intussusception.
- It demonstrates superior safety, accuracy, and success rates, while mitigating radiation risks.
Abstract:
A comparison was made of the efficacy of ultrasound guided Hartmann's solution hydrostatic reduction on 23 patients (US group) with the same number of consecutive patients in whom hydrostatic reduction was done by barium enema (BE group) under fluoroscopy for childhood intussusception. The US group was diagnosed by ultrasound scan and reduction was attempted under the guidance of ultrasonography with Hartmann's solution at 100 mm Hg pressure. Excluded were patients older than 12 years, patients in shock, patients with peritonitis, bowel perforation, and gross abdominal distension as well as recurrent intussusception of more than three episodes. There were three patients excluded in this group. The diagnosis of intussusception and complete reduction were confirmed by gastrografin enema. This US group had three recurrences (3 of 26, 11.5%), one lead point (1 of 23, 4.4%), and 19 successful reductions (19 of 26, 73%). Incidentally, there were also three patients excluded in this period of barium enema reduction. There was only one recurrence (1 of 24, 4.2%), one leadpoint (1 of 23, 4.4%), and 12 successful reductions (12 of 24, 50%) in these 23 BE patients. The success rates for the ileo-colic intussusceptions with Hartmann's solution reduction and barium enema reduction were 91% (19 of 21) and 55% (12 of 22), respectively (P = .00865). There was no complication in either group, and the accuracy of diagnosing a complete reduction was 100% in both forms of reduction. Hence, ultrasound-guided hydrostatic reduction for childhood ileocolic intussusception is preferred because it is safe, accurate, has a higher success rate, and can avoid radiation exposure risk.