A Comparative Study of Non-operative Management in Childhood Intussusception

PURPOSE: Intussusception is one of the most common causes of intestinal obstruction in children under the age of 2 years, especially in male. In this study, we compared the results of pressure reductions for various treatment methods and identified the factors related to reduction failure. METHODS: From Jan. 1996 to Dec. 1997, 87 barium reductions and 127 air reductions were performed for childhood in tussusception. Success rates of these non-operative managements and factors affecting those rates were analyzed. RESULTS: 1) When only ileocolic intussusceptions were considered in order to exclude the effect of different type of intussusceptions, the success rate for air reduction (AR) was 83.5%, which was significantly higher than 71.8% in barium reduction (BR). 2) Factors affecting reduction failure were history of preceding upper respiratory infection, fever (> or =38oC) and symptom duration in BR, and abdominal distension, leukocytosis (> or =10,000/mm3), and symptom duration in AR. 3) Bowel perforations were occurred in 3 cases of AR, but all of these cases showed bowel wall infarction requiring bowel resection, and complications due to perforations were minimal. There were no BR-related complications in BR. 4) Intussuception recurred in 7.4% of all cases; 4.9% after BR, 9.3% after AR. The mean intervals between previous reduction and recurrence were 37.0 (range 1-88) days in BR and 64.3 (range 2-283) days in AR. Recurrences occurred within 48 hours after reduction in 2 cases of BR and in 3 cases of AR. CONCLUSION: Compared with conventional barium reduction, air reduction had a relatively higher success rate in managing childhood intussusception, in spite of a slightly higher risk of bowel perforation. However, perforation did not significantly affect the clinical course. Therefore, air reduction is one of the good alternative of conventional barium reduction for managing childhood intussusception.

A Clinical Analysis of Intussusception in Infants and Children

PURPOSE: Intussusception is a very common pediatric problem and needs early management. This study evaluated the risk factors of intussusception in infants and children for early diagnosis and treatment. METHODS: 216 cases of pediatric intussusception occurring between 1993 and 1999 in Mokpo Catholic Hospital were investigated retrospectively. 164 patients treated with barium reduction comprised the barium reduction (BR) group and 52 patients treated with manual reduction or bowel resection was operation (OP) group. RESULTS: The age incidence under 1 year old was 108 patients (65.9%) in BR group, 45 patients (86.5%) in OP group. Male to female ratio was 1.8:1 in BR and 1.7:1 in OP, respectively. In the seasonal distribution spring was more common in both group (34.1%, 34.6%). 60.4% in BR group, 76.9% in OP group were revealed leukocytosis above 10.000/mm3 in serum. Previous combined diseases were upper respiratory infection (31.7%, 42.3%), acute gastroenteritis (1.2%, 1.9%) and multiple familial polyposis (0.5% in BR group). The frequent symptoms and signs were bloody stool (86.0%,92.3%), abdominal pain and irritability (86.6%, 82.7%), vomiting (76.9%, 67.3%), and abdominal mass (56.7%, 76.9%). Tachycardia was 12.2% in BR and 44.2% in OP. In plain abdominal radiography, intestinal obstructive pattern was present in 5.5% of BR group and 53.8% of OP group. Success rate of barium reduction within 24 hours after symptom appearance was 82.3%. Within 24-48 hours was 61.1%, above 48 hours was 25%. There was a statistically significant difference between BR group and OP group of patients under 1 year old, with tachycardia, symptoms for longer than 48 hours and obstructive pattern on plain abdominal radiography (p<0.05). Of surgical cases, 84.6% were idiopathic. The common anatomical type was ileo-colic type (53.9%). The methods of operation were manual reduction (94.2%) and bowel resection (5.8%). Postoperative complications occurred in 4 cases; 3 cases of wound infection and 1 case of pulmonary complication. Recurrence rate was 12.8% in BR group. CONCLUSION: Risk factors of high incidence such as under 1 year old, severe obstructive pattern on the plain abdominal radiograph, symptoms for longer than 48 hours, and tachycardia, were related with a low success rate of barium reduction. Therefore, a gentle barium enema is recommended in high risk patients for diagnosis and prompt surgical intervention.

Comparison of Barium Reduction and Pneumatic Reduction of Intussusception in Children: A Surgeon's View

PURPOSE: Pneumatic reduction has rapidly replaced traditional barium reduction owing to its potential advantages, such as higher reduction rate and greater safety; however, the effects on surgery after reduction failure have not been studied. In this study, we evaluated the influences of attempted barium and pneumatic reductions on subsequent surgical procedures. METHODS: One hundred and sixty-one barium reductions were performed on 158 patients while 153 pneumatic reductions were performed on 145 patients. Statistical comparisons of these two reduction methods were made regarding the following variables: the reduction rates, frequencies of bowel perforations and recurrences, mean operation times, fasting periods, and durations of admission. RESULTS: The reduction rates were similar for both groups with barium reduction being successful in 67.1% of the cases (108/161) and pneumatic reduction in 69.3% (106/153). Two cases of bowel perforation occurred during the pneumatic reductions, none were noted during the barium reductions. Recurrence of intussusception was noted in three cases initially reduced with barium and in nine cases reduced pneumatically. The mean operation time (130.7 minutes vs. 81.7 minutes), postoperative fasting time (61.6 hours vs. 37.6 hours), and duration of admission (6.7 days vs. 5.4 days) were significantly prolonged in the pneumatic reduction group. CONCLUSION: A part from a comparable reduction rate pneumatic reduction demonstrated no favorable outcome relative to barium reduction. Furthermore, it resulted in some obstacles to surgery and recovery, such as prolonged operation time, fasting period, and duration of admission.

Saline reduction of intussusception under ultrasound guidance

No abstract available.