title: Childhood intussusception: ultrasound-guided Hartmann's solution hydrostatic reduction or barium enema reduction?
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.
authors.affiliation: Department of Surgery, University of Hong Kong, Queen Mary Hospital, Hong Kong.
authors.forename: K L
authors.initials: KL
authors.lastname: Chan
authors.forename: H
authors.initials: H
authors.lastname: Saing
authors.forename: W C
authors.initials: WC
authors.lastname: Peh
authors.forename: G H
authors.initials: GH
authors.lastname: Mya
authors.forename: W
authors.initials: W
authors.lastname: Cheng
authors.forename: P L
authors.initials: PL
authors.lastname: Khong
authors.forename: C
authors.initials: C
authors.lastname: Lam
authors.forename: W W
authors.initials: WW
authors.lastname: Lam
authors.forename: L L
authors.initials: LL
authors.lastname: Leong
authors.forename: L C
authors.initials: LC
authors.lastname: Low
mesh_terms: D001466:Barium Sulfate / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D003287:Contrast Media; D003974:Diatrizoate Meglumine; D004733:Enema; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D006874:Hydrostatic Pressure; D007077:Ileal Diseases / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D007223:Infant; D007443:Intussusception / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D007552:Isotonic Solutions / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D015641:Radiography, Interventional; D012008:Recurrence; D000077325:Ringer's Lactate; D012307:Risk Factors; D012449:Safety; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D003287:Contrast Media; D007552:Isotonic Solutions; D000077325:Ringer's Lactate; D001466:Barium Sulfate; D003974:Diatrizoate Meglumine