title: Twenty years' experience for reduction of ileocolic intussusceptions by saline enema under sonography control.
abstract: BACKGROUND
  Ultrasonography is a well-established efficient diagnostic tool for ileocolic intussusceptions in children. It can also be used to control hydrostatic reduction by saline enemas. This reduction method presents the advantage of avoiding radiations. Parents can even stay with their children during the procedure, which is comforting for both. The purpose of this study was to present our 20 years' experience in intussusception reductions using saline enema under ultrasound control and to assess its efficiency and safety.
  
  
  METHODS
  This retrospective single center study included patients with ileocolic intussusceptions diagnosed by ultrasound between June 1993 and July 2013. We excluded the data of patients with spontaneous reduction or who underwent primary surgery because of contraindications to hydrostatic reduction (peritonitis, medium or huge abdominal effusion, ischemia on Doppler, bowel perforation). A saline enema was infused into the colon until the reduction was sonographically confirmed. The procedure was repeated if not efficient. Light sedation was practiced in some children.
  
  
  RESULTS
  Eighty-tree percent of the reductions were successful with a median of 1 attempt. Reduction success decreased with the number of attempts but was still by 16% after 4 attempts. The early recurrence rates were 14.5%, and 61.2% of those had a successful second complete reduction. Forty-six patients needed surgery (11 of them had a secondary intussusception). Sedation multiplies success by 10. In this period, only one complication is described.
  
  
  CONCLUSIONS
  Ultrasound guided intussusception reduction by saline enema is an efficient and safe procedure. It prevents exposure of a young child to a significant amount of radiation, with similar success rate. We had very low complication rate (1/270 cases or 3‰). The success rate could be increased by standardized procedures including: systematic sedation, trained radiologists, accurate pressure measurement, and number and duration of attempts.
authors.affiliation: Department of Pediatric Surgery, University Hospital Hautepierre, 67098, Strasbourg Cedex, France; Departement of Pediatric Surgery, Pediatric Clinic, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg. Electronic address: flaumvalerie@hotmail.fr.
authors.forename: Valérie
authors.initials: V
authors.lastname: Flaum
authors.affiliation: Department of Pediatric Surgery, University Hospital Hautepierre, 67098, Strasbourg Cedex, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Schneider
authors.affiliation: Departement of Pediatric Surgery, Pediatric Clinic, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg.
authors.forename: Cindy
authors.initials: C
authors.lastname: Gomes Ferreira
authors.affiliation: Departement of Pediatric Surgery, Pediatric Clinic, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg.
authors.forename: Paul
authors.initials: P
authors.lastname: Philippe
authors.affiliation: Department of Pediatric Radiology, University Hospital Hautepierre, Strasbourg, France.
authors.forename: Consuelo
authors.initials: C
authors.lastname: Sebastia Sancho
authors.affiliation: Department of Pediatric Surgery, University Hospital Hautepierre, 67098, Strasbourg Cedex, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Lacreuse
authors.affiliation: Department of Pediatric Surgery, University Hospital Hautepierre, 67098, Strasbourg Cedex, France.
authors.forename: Raphael
authors.initials: R
authors.lastname: Moog
authors.affiliation: Department of Pediatric Surgery, University Hospital Hautepierre, 67098, Strasbourg Cedex, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Kauffmann
authors.affiliation: Department of Pediatric Radiology, University Hospital Hautepierre, Strasbourg, France.
authors.forename: Meriam
authors.initials: M
authors.lastname: Koob
authors.affiliation: Department of Pediatric Radiology, University Hospital Hautepierre, Strasbourg, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Christmann
authors.affiliation: Department of Pediatric Radiology, University Hospital Hautepierre, Strasbourg, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Douzal
authors.affiliation: Statistics and Public Health Department, Medicine Faculty, Strasbourg, France.
authors.forename: François
authors.initials: F
authors.lastname: Lefebvre
authors.affiliation: Department of Pediatric Surgery, University Hospital Hautepierre, 67098, Strasbourg Cedex, France.
authors.forename: François
authors.initials: F
authors.lastname: Becmeur
mesh_terms: D004733:Enema / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007077:Ileal Diseases / Q000000981:diagnostic imaging* / Q000628:therapy*; D007223:Infant; D007443:Intussusception / Q000000981:diagnostic imaging* / Q000628:therapy*; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D012965:Sodium Chloride / Q000008:administration & dosage*; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D012965:Sodium Chloride
keywords: Children; Intussusception; Radiation; Reduction; Saline enema; Sonography; Ultrasound