|
Hydrostatic Reduction of Intussusception in Children:Feasibility
and Limitations of the Technique
Ahmed Nofal
Unit of Pediatric Surgery, Department of Surgery, Faculty of
Medicine, Tanta University, Egypt
Tanta Med. Sc. J 2008; 3(3):117-126
Article type: Original article
Background/Aim: Intussusception is a common abdominal emergency in
infants that can lead to intestinal necrosis and even death. The
management of this condition is controversial, some advocating
primary surgical treatment and others preferring hydrostatic
reduction. The objective of this study was to determine the
feasibility and limitations of hydrostatic reduction of
intussusception in children and the indications of surgery in such
cases. Patient & Methods: Over a period of 3 years, the children
with clinical features of intussusception were evaluated and the
diagnosis was confirmed in them by ultrasound. The patients
presented with signs of complicated intussusception were
resuscitated then taken directly for surgical management. The other
patients were taken for hydrostatic reduction using gastrografin
enema. The cases with successful reduction were kept under
observation for about 24 hours. The cases with failed reduction were
taken for surgery. The Demographic data, the clinical features and
the operative findings of the patients were analyzed. Results: Of 33
patients with intussusception, hydrostatic reduction was attempted
in 29 patients (87.9%), and successful reduction could be obtained
in 20 of them (69% success rate). The total number of patients
managed by surgery was 13 patients (39%); 3 patients presented with
complicated intussusception, one patient the contrast study did not
visualize the intussusception in him and 9 patients with failed
hydrostatic reduction. At surgery, the 3 cases of complicated
intussusception had gangrenous bowel that required resection, and 2
cases had intussusception secondary to inverted Meckel's
diverticulum. With the exclusion of the cases of complicated
intussusception, there was no significant difference in demographic
& clinical features between the patients successfully managed by
hydrostatic reduction and the patients required surgical management
except for the presence of leucocytosis. Conclusion: Hydrostatic
reduction should be attempted in uncomplicated cases of
intussusception in children; it has high success rate, low morbidity
and short hospital stay. Surgery should be reserved for the
complicated cases, for the cases with pathologic lead point, and for
the cases with failed hydrostatic reduction.
ICID 874413 |