Sonographically guided hydrostatic reduction of intussusception in children.
OBJECTIVE
The aim of this study was to assess the efficacy of sonographically guided hydrostatic enema in therapeutic reduction of intussusception in children and to determine whether certain factors may predict the outcome of this technique.


METHODS
We retrospectively reviewed the medical records and sonographic examinations of 83 consecutive children sonographically diagnosed with 101 cases of intussusception over a 40-month period. In 99 cases, sonographically guided hydrostatic reduction was attempted. The presence of free peritoneal fluid, the presence of fluid inside the intussusception, and the initial location of the intussusception, as confirmed by sonography, along with the level of experience of the radiologist who performed the reduction were statistically analyzed to determine their effect on outcome. A p value less than 0.05 was considered significant.


RESULTS
In 88 (89%) of the 99 cases, hydrostatic reduction was successful. No complications during or after hydrostatic enema were noted. The success rate was significantly lower among patients whose intussusception was located in the left side of the abdomen (p < 0.01) or contained entrapped fluid (p < 0.02) or those in whom hydrostatic reduction was not performed by an experienced sonologist (p < 0.01). The presence of free peritoneal fluid was not a predictor of outcome (p > 0.1). No complications during or after hydrostatic enema were noted.


CONCLUSIONS
Sonographically guided hydrostatic reduction of intussusception is safe and effective. We recommend that this method be attempted before surgery is considered, even in cases in which the intussusception contains entrapped fluid or is located in the left side of the abdomen. The level of experience of the radiologist who performs the reduction significantly affects the results of this procedure and should be carefully considered, particularly in cases in which initial sonography reveals the presence of risk factors.
Crystal
Pavel
P
Department of Radiology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O.B. 151, Beer-Sheva 84105, Israel.
Hertzanu
Yancu
Y
Farber
Boris
B
Shabshin
Noga
N
Barki
Yehiel
Y
D002675:Child, Preschool; D004733:Enema; D005260:Female; D006801:Humans; D006874:Hydrostatic Pressure; D007223:Infant; D007443:Intussusception / Q000000981:diagnostic imaging* / Q000628:therapy*; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography