title: Enema reduction of intussusception: the success rate of hydrostatic and pneumatic reduction.
abstract: OBJECTIVE
  Intussusception is a common surgical emergency in infants and children. The incidence of intussusception is from one to four per 2,000 infants and children. If there is no peritonitis, perforation sign on abdominal radiographic studies, and nonresponsive shock, nonoperative reduction by pneumatic or hydrostatic enema can be performed. The purpose of this study was to compare the success rates of both the methods.
  
  
  METHODS
  Two institutional retrospective cohort studies were performed. All intussusception patients (ICD-10 code K56.1) who had visited Chiang Mai University Hospital and Siriraj Hospital from January 2006 to December 2012 were included in the study. The data were obtained by chart reviews and electronic databases, which included demographic data, symptoms, signs, and investigations. The patients were grouped according to the method of reduction followed into pneumatic reduction and hydrostatic reduction groups with the outcome being the success of the reduction technique.
  
  
  RESULTS
  One hundred and seventy episodes of intussusception occurring in the patients of Chiang Mai University Hospital and Siriraj Hospital were included in this study. The success rate of pneumatic reduction was 61% and that of hydrostatic reduction was 44% (P=0.036). Multivariable analysis and adjusting of the factors by propensity scores were performed; the success rate of pneumatic reduction was 1.48 times more than that of hydrostatic reduction (P=0.036, 95% confidence interval [CI] =1.03-2.13).
  
  
  CONCLUSIONS
  Both pneumatic and hydrostatic reduction can be performed safely according to the experience of the radiologist or pediatric surgeon and hospital setting. This study showed that pneumatic reduction had a higher success rate than hydrostatic reduction.
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Chiang Mai University Hospital, Chiang Mai, Thailand.
authors.forename: Jiraporn
authors.initials: J
authors.lastname: Khorana
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Chiang Mai University Hospital, Chiang Mai, Thailand.
authors.forename: Jesda
authors.initials: J
authors.lastname: Singhavejsakul
authors.affiliation: Division of Gastroenterology, Department of Pediatrics, Chiang Mai University Hospital, Chiang Mai, Thailand.
authors.forename: Nuthapong
authors.initials: N
authors.lastname: Ukarapol
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Mongkol
authors.initials: M
authors.lastname: Laohapensang
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Thammasat University Hospital, Pathumthani, Thailand.
authors.forename: Junsujee
authors.initials: J
authors.lastname: Wakhanrittee
authors.affiliation: Center of Excellence in Applied Epidemiology, Thammasat University Hospital, Pathumthani, Thailand.
authors.forename: Jayanton
authors.initials: J
authors.lastname: Patumanond
keywords: hydrostatic reduction; intussusception; pneumatic reduction; success rate