title: Indications for repeated enema reduction of intussusception in children.
abstract: BACKGROUND
  Intussusception is a common abdominal emergency in early childhood. It is idiopathic in more than 90% of cases with incidence of 1.5-4 per 1,000 live births. The treatment of choice is nonoperative hydrostatic or air enema reduction.
  
  
  OBJECTIVE
  The aim of the study was to evaluate the influence of clinical presentation and symptom duration in non-operative treatment, considering the indications for delayed enema reduction and its efficacy.
  
  
  METHODS
  From the total number of 107 patients with intusussception, aged from 2 months to 14 years (median 9 months), 102 (95%) patients with ileo-colic intussusceptions were treated initially by ultrasound guided saline enema. Records were reviewed for patients with failed initial treatment and delayed repeated enemas or operative procedure. The predictor variable included duration of presenting symptoms.
  
  
  RESULTS
  Successful treatment by hydrostatic saline enemas had 58/102 (57%) patients. Success in reduction was greater it symptom duration was < 24 hours (54/62 cases; 87%, p < 0.001), compared with > 24 hours, (4/45 cases; 9%). Despite failed initial attempts, enema reduction was reattempted in 12 patients, with success in 7/12 (60%) patients. Children with symptom duration > 24 hours had a greater risk of requiring surgery (41/45 cases; 91%, p < 0.001), including 5 (5%) patients with ileo-ileal intussusceptions.
  
  
  CONCLUSIONS
  The accuracy of ultrasound guided saline enema in intussusception reduction is high. Delay in presentation decreases success of non-operative treatment. Delayed enema reduction is important therapeutic option for intussusceptions. Surgical treatment is indicated in cases of complications.
authors.forename: Dragana
authors.initials: D
authors.lastname: Vujović
authors.forename: Marija
authors.initials: M
authors.lastname: Lukac
authors.forename: Aleksandar
authors.initials: A
authors.lastname: Sretenović
authors.forename: Tamara
authors.initials: T
authors.lastname: Krstajić
authors.forename: Vesna
authors.initials: V
authors.lastname: Ljubić
authors.forename: Sanja Sindjić
authors.initials: SS
authors.lastname: Antunović
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D013505:Digestive System Surgical Procedures / Q000706:statistics & numerical data; D004733:Enema / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007443:Intussusception / Q000188:drug therapy* / Q000453:epidemiology / Q000601:surgery; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome