Does the length of the history influence the outcome of pneumatic reduction of intussusception in children?
OBJECTIVE
Intussusception is the most common cause of acute abdomen in infants and preschool children. Nonoperative reduction using air enema is an established treatment in children with intussusception. The aim of this study was to determine whether length of the history influences the outcome of pneumatic reduction of intussusception in children?


METHODS
The medical records of 256 consecutive children with intussusception between July 1998 and June 2010, who underwent air enema reduction regardless of the length of the history were reviewed. In all 256 patients, intussusception was confirmed by ultrasound before proceeding to air enema.


RESULTS
The length of history ranged from 2 to 240 h with median time of 18.5 h. The median age in 256 patients was 7 months (range 1 day to 12 years). The presenting clinical features included irritability/abdominal pain (77%), vomiting (80%), bleeding per rectum (36%) and palpable abdominal mass (50%). Air enema reduction was successful in 234 (91.5%) of the 256 patients. In 22 (8.5%) patients, air enema failed to reduce the intussusception and 3 (1.1%) of these patients had colonic perforation during the procedure. All 22 patients required surgery. The duration of symptoms did not influence the outcome of pneumatic reduction. 37 (14%) patients developed recurrence after successful pneumatic reduction of intussusception, with 58% presenting within 48 h of the initial procedure.


CONCLUSIONS
Our data suggest that pneumatic reduction should be first-line treatment in all children with intussusception regardless of the length of the history.
Children's University Hospital, Temple Street, Dublin 1, Ireland.
Farhan
F
Tareen
Stephanie
S
Ryan
Stefano
S
Avanzini
Victor
V
Pena
Danielle
D
Mc Laughlin
Prem
P
Puri
D000285:Administration, Rectal; D000388:Air; D000399:Air Pressure; D002648:Child; D002675:Child, Preschool; D004733:Enema / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007443:Intussusception / Q000628:therapy*; D008297:Male; D008487:Medical History Taking / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
Int J Colorectal Dis. 2009 Oct;24(10):1187-92
19418060
Radiology. 1992 Jun;183(3):681-4
1584919
J Gastroenterol Hepatol. 2006 May;21(5):842-6
16704533
J Pediatr. 1998 May;132(5):836-9
9602196
Eur Radiol. 2007 Sep;17(9):2411-21
17308922
Pediatr Radiol. 2004 Feb;34(2):97-108; quiz 187
14634696
J Accid Emerg Med. 1995 Sep;12(3):182-6
8581242
J Pediatr Surg. 1996 Jun;31(6):859-61
8783124
Arch Pediatr Adolesc Med. 1994 May;148(5):474-8
8180637
J Am Coll Surg. 2005 Dec;201(6):830-3
16310684
Acta Paediatr. 2007 Aug;96(8):1199-202
17590197
Pediatr Surg Int. 2008 Mar;24(3):311-3
18097672
J Pediatr Surg. 1986 Dec;21(12):1201-3
3794988
Pediatr Surg Int. 2006 Nov;22(11):901-4
17021742
J Pediatr Surg. 2003 Jul;38(7 Suppl):60-4
12866017
Eur J Pediatr Surg. 2002 Dec;12(6):387-90
12548491
Emerg Med Australas. 2007 Feb;19(1):45-50
17305660
Radiology. 1998 Mar;206(3):721-4
9494491