Hydrostatic reducibility of intussusception among different age groups in paediatric population-a descriptive study
DOI:
https://doi.org/10.18203/2349-2902.isj20170223Keywords:
Hydrostatic reduction, Intussusception, Ultrasound, IleocolicAbstract
Background: Intussusception is one of the most frequent causes of bowel obstruction in infants and toddlers. In children, it is often an idiopathic condition and treated non-surgically by radiologic reduction. Primary aim of study was to analyse the outcome of hydrostatic reduction of intussusception across different paediatric age group patients admitted in a medical college hospital.
Methods: This is a hospital based descriptive study conducted in tertiary care centre for one year duration in 2014-2015. 90 patients admitted with diagnosis of intussusceptions for hydrostatic reduction were interviewed with the proforma and details were collected. The procedural detail of hydrostatic reduction was also collected. Patients were followed up for a period of 48 hours post successful hydrostatic reduction.
Results: Hydrostatic reducibility of intussusception was 63.3% in less than 3 months age group compared to 93.3% each in other two groups. Overall hydrostatic reducibility was of 83.3%, while 16.7% went for laparotomy. First group had 36.7% cases gone for laparotomy. Analysis of each of the study variables was done to find out their association with hydrostatic reducibility. Only duration, bleeding per rectum, lethargy, dehydration, side of lesion and total count were found to have a statistically significant p value. Logistic regression analysis of the above five variables revealed that only the ‘duration of symptoms’ had a statistically significant independent association with hydrostatic reducibility of intussusception ,with a p value of 0.033 and odds ratio 12.477. 5.3% of cases of first group had recurrence within 48 hours of hydrostatic reduction, while 10.7% and 21.4% of cases from second and third group respectively had recurrence within 48 hours of reduction. Overall recurrence of intussusception within 48hours is 13.3%.
Conclusions: Hydrostatic reduction of intussusception is more successful in paediatric age group > 3 months compared to < 3 months. Shorter duration of symptoms, especially < 48 hours may have a favourable effect on hydrostatic reducibility of pediatric intussusception. Rate of recurrence of intussusception within 48 hours of successful hydrostatic reduction is 13.3 per 100 paediatric cases.
Metrics
References
Lloyd DA, Kenny SE. The surgical abdomen. In pediatric gastrointestinal disease: pathopsychology, diagnosis, management, 4th, Walker WA Goulet o, Kleinman RE, et al (Eds), BC decker, Ontario; 2004:604.
Mandeville K, Chien M, Willyerd FA. Intussusception: clinical presentations and imaging characteristics. Pediatr Emerg Care. 2012;28:842.
Blakelock RT, Beasley SW. The clinical implications of non-idiopathic intussusception. Pediatr Surg Int. 1998;14:163.
Navarro O, Daneman A. Intussusception. Part 3: Diagnosis and management of those with an identifiable or predisposing cause and that reduce spontaneously. Pediatr Radiol. 2004;34:305.
DelPozo G, Albillos JC, Tejedor D. Intussusception in children: current concepts in diagnosis and enema reduction. Radiographics. 1999;19:299.
Daneman A, Navarro O. Intussusception. Part 2: an update on the evolution of management. Pediatr Radiol. 2004;34:97.
Shekherdimian S, Lee SL, Sydorak RM, Applebaum H. contrast enema for pediatric intussusception: is reflux in to the terminal ileum necessary for complete reduction? J Pediatr Surg. 2009;44:247.
Ein SH, Shandling B, Reilly BJ, Stringer DA. Hydrostatic reduction of intussusceptions caused by lead points. J Pediatr Surg. 1986;21:883.
Dobranowski J. Manual of Procedures in Gastrointestinal Radiology, Springer Verlag, New York; 1990.
Kim YG, Choi BI, Yeon KM. Diagnosis and treatment ofchildhood intussusception using real time ultrasonography and saline enema. Preliminary report. J Korean Soc Med Ultrasound. 1982;1:66-70.
Guo JZ, Ma XY, Zhou QH. Results of air pressure enema reduction of intussusception: 6,396 cases in13 years. J Pediatr Surg. 1986;21:1201.
Stringer DA, Ein SH. Pneumatic reduction: advantages, risks and indications. Pediatr Radiol. 1990;20:475.
Fallon SC, Lopez ME, Zhang W. Risk factors for surgery in pediatric intussusception in the era of pneumatic reduction. J Pediatr Surg. 2013;45:1032.
Van den Ende ED, Allema JH, Hazebroek FW, Breslau PJ. Success with hydrostatic reduction of intussusception in relation to duration of symptoms. Arch Dis Child. 2005;90:1071.
Yang CM, Hsu HY, Tsao PN. recurrence of intussusception in childhood. Acta Pediatr Taiwan. 2001;42:158.
Stein M, Alton DJ, Daneman A. Pneumatic reduction of intussusception: 5 year experience. Radiol. 1992;183:681.
Daneman A, Alton DJ, Lobo E. Patterns of recurrence of intussusception in children: a 17 year review. Pediatr Radiol. 1998;28:913.
Gray MP, Li SH, Hofmann RG, Goerlick MH. Recurrence rates after intussusception enema reduction: a meta-analysis. Pediatr. 2014;134:110.
Frankie B. Fike, Vincent E. Mortellaro. Predictors of failed enema reduction in childhood intussusception. J Pediatr Surg. 2012.
Suzanne Schuh, David E. Wesson. Intussusception in children 2 years of age or older. CMAJ. 1987:136.
Downloads
Published
How to Cite
Issue
Section
