Epidemiological characteristics, treatment, and outcomes of 586 cases of intussusception: a 4-year retrospective study in China.

Objective: This study aims to retrospectively analyze the epidemiological and clinical characteristics of acute intussusception in a tertiary-care pediatric hospital in China over 4 years and evaluate the effectiveness and recurrence of fluoroscopy-guided pneumatic reduction (FGPR) and ultrasound-guided hydrostatic reduction (UGHR). Methods: This retrospective study was conducted from January 2019 to December 2022 involving children admitted and managed for acute intussusception in a tertiary-care pediatric hospital in China. The epidemiology, clinical features, and therapeutic effects were analyzed using IBM SPSS Statistics 20.0. Results: The study included 401 boys (68.43%) and 185 girls (31.57%) aged from 2 months to 12 years. The most common symptoms reported were abdominal pain or paroxysmal crying (95.73%), vomiting (45.39%), and bloody stool (7.34%). Vomiting and bloody stool became atypical with increasing age (P < 0.001). The total success cases of reduction accounted for 563 cases (96.08%), and the recurrent cases accounted for 71 cases (12.12%). No significant difference was observed in the success or recurrence rates between FGPR and UGHR (P > 0.05). Abdominal pain was an independent protective factor for successful enema (P < 0.01, OR = 72.46), while bloody stool (P < 0.01, OR = 0.06) and older age were independent risk factors (P < 0.001, OR = 0.51). Of the 71 patients with recurrent intussusception, 29 were successfully reduced by enema, and the other 23 required surgical reduction. Twelve of the surgical cases were secondary intussusception, including three cases of Meckel's diverticulum, five cases of polyps, and four cases of non-Hodgkin lymphoma. Conclusion: The epidemiological characteristics of children with intussusception in Xiamen showed peculiarity with a higher male-to-female ratio, older age at diagnosis, and no significant seasonality. Both FGPR and UGHR were effective and safe for intussusception, and surgical reduction was essential for patients with failed enema reduction.

Developing a Nomogram for Predicting Surgical Intervention in Pediatric Intussusception After Pneumatic Reduction: A Multicenter Study from China.

Purpose: The objective of this study was to develop and validate a nomogram for predicting the need for surgical intervention in pediatric intussusception after pneumatic reduction. Patients and Methods: This retrospective study analyzed the clinical data of children with acute intussusception admitted to four hospitals in China from January 2019 to January 2022. Based on the results of pneumatic reduction, the patients were divided into two groups: the successful reduction group (control group) and the failed reduction group (operation group). The total sample was randomly divided into a training set and a validation set in a 7:3 ratio. Logistic regression analysis was performed to establish a predictive model for surgical risk. Results: A total of 1041 samples were included in this study, with 852 in the control group and 189 in the operation group. Among the total sample, 728 cases were used for training and 313 cases were used for validation. Logistic regression analysis of the training set identified age, time of abdominal pain, presence or absence of hematostoecia, C-reactive protein value from blood test on admission, and nested position indicated by B-ultrasound as independent predictors of intussusception intervention. Based on the five independent risk factors identified through multivariate logistic regression, a nomogram was successfully constructed to predict the failure of resetting by air enema under X-ray. Conclusion: A nomogram was developed to predict the need for surgical intervention after intussusception pneumatic reduction in children. The nomogram was based on clinical risk factors including age, time of abdominal pain, presence or absence of blood in stool, value of C-reactive protein in blood test on admission, and nested position indicated by B-ultrasound. Our internal validation demonstrated that this nomogram can serve as a useful tool for identifying risk factors associated with failure of air enema in children with intussusception.

A comparison of the success rate of pneumatic reduction in intussusception between general anesthesia and deep sedation: a randomized controlled trial.

PURPOSE: This study was aimed to compare the success rate between patients who underwent general anesthesia and deep sedation. METHODS: Patients who were diagnosed with intussusception and had no contraindications would receive non-operative treatment first by undergoing pneumatic reduction. The patients were then split in to two groups: one group underwent general anesthesia (GA group), while the other underwent deep sedation (SD group). This study was a randomized controlled trial which compared success rate between two groups. RESULTS: A total of 49 episodes diagnosed with intussusception were random into 25 episodes in GA group and 24 episodes in SD group. There was no significant difference in baseline characteristic between the two groups. The success rates of GA group and SD group were equally 88.0% (p = 1.00). Sub-analysis of the success rate was lower in the patients with high-risk score for failed reduction. (Chiang Mai University Intussusception (CMUI) failed score in success VS failed = 6.9 ± 3.2 vs. 10.3 ± 3.0 p = 0.017). CONCLUSION: General anesthesia and deep sedation offered similar success rates. In cases of high risk of failure, general anesthesia should be considered to accommodate the switch to surgical management in the same setting if the non-operative approach fails. The appropriate treatment and sedative protocol also increase the success of reduction.

Ultrasound-guided reduction of intussusception in infants in a developing world: saline hydrostatic or pneumatic technique?

Non-operative reduction has emerged as first line in the management of uncomplicated intussusception. The aim of this study was to compare the outcome of ultrasound-guided saline hydrostatic reduction and ultrasound-guided pneumatic reduction of intussusception in infants. This is a prospective study of infants with uncomplicated intussusception confirmed by ultrasound over a period of 21 months from December 2018 to August 2020. Fifty-two (69.3%) out of seventy-five infants were eligible and randomized based on simple random sampling technique into two groups: Group A included patients who had ultrasound-guided hydrostatic (saline) reduction; Group B included patients who had ultrasound-guided pneumatic (air) reduction. The success rates, time to reduction and complication rates were assessed. The success rates, between the saline hydrostatic reduction group and pneumatic reduction group, were comparable [17 (65.4%) versus 19 (73.1%); relative risk (RR) 0.8; 95% confidence interval (CI) 0.6-1.2; p = 0.54]. The mean time to reduction was higher in the saline hydrostatic reduction group (15.4 ± 5.1 min versus 10.8 ± 4.1 min; p = 0.003). There was no statistically significant difference in the perforation and recurrence rates between the two groups. CONCLUSION: Saline hydrostatic reduction and pneumatic reduction of uncomplicated intussusception under ultrasound guidance in infants might have comparable outcomes. However, pneumatic reduction may be faster. WHAT IS KNOWN: • Ileocolic intussusception is the most common cause of intestinal obstruction in infants. • Ultrasonography is useful in the diagnosis and non-operative treatment of ileocolic intussusception. WHAT IS NEW: • Ultrasound-guided hydrostatic enema and ultrasound-guided pneumatic enema are similarly effective and safe techniques in the reduction of ileocolic intussusception. • Reduction of ileocolic intussusception under ultrasound guidance is a great technique that may prove useful in the developing world due to lower cost of required equipment.

Factors Associated with a Failed Nonoperative Reduction of Intussusception in Children.

AIMS: The aim of this study was to evaluate the factors associated with the failure of nonoperative reduction of intussusception in children. METHODS: A retrospective study was conducted in a tertiary care pediatric surgery hospital. The children admitted to the department of pediatric surgery between November 2013 and February 2020 with the diagnosis of Intussusception were included. RESULTS: A total of 106 (67%) children underwent pneumatic reduction. Eighty-nine (84%) children had a successful reduction. A higher rate of failed reduction was found in children who presented at or after 48 h of the onset of symptoms (P = 0.03) and abdominal distension at presentation (P < 0.002). On multiple logistic regression analysis, the children presenting at or after 48 h of the onset of symptoms (odds ratio [OR] = 11.3; P = 0.039) and abdominal distension at presentation (OR = 4.46; P = 0.021) were found to be associated with increased risk of failure of nonoperative reduction. The variables age <1 year, weight <10 kg, pain abdomen, vomiting, bilious vomiting, fever, bleeding per rectum, and palpable mass were not associated with the failed nonoperative reduction. The variables, presentation at or after 48 h of the onset of symptoms (OR = 2.812; P = 0.045) and abdominal distension at presentation (OR = 8.758; P = 0.000) were found to be associated with an increased need for surgery. CONCLUSION: The risk factors for failed nonoperative reduction of intussusception include a presentation at or after 48 h of the onset of symptoms and the presence of abdominal distension at presentation. The delayed presentation was associated with the increased need for surgery and increased chances of intestinal nonviability.

Management and outcomes of paediatric ileocolic intussusception at a paediatric tertiary care hospital: A retrospective cohort study.

BACKGROUND: Rapid reduction of ileocolic intussusception is important to minimize the compromise in blood flow to the affected bowel segment. This study aimed to quantify the potentially modifiable time between diagnosis and initiation of pneumatic reduction, identify factors associated with delays, and characterize the outcomes of pneumatic reduction in a recent cohort. METHODS: This retrospective observational study occurred at a tertiary care paediatric hospital with a consecutive sample of all children with ileocolic intussusception September 2015 through September 2018. The primary outcome was the time between ultrasound diagnosis of intussusception and the beginning of pneumatic reduction. Independent variables were age of the patient, time of day of arrival, transfer from another facility, and intravenous access prior to ultrasound. Outcomes of pneumatic reduction were expressed as proportions. RESULTS: There were 103 cases of ileocolic intussusception (among 257,282 visits) during the study period. The median time between diagnostic confirmation and initiation of reduction was 36 minutes. This was shorter for transferred patients and children with intravenous access prior to ultrasound. One perforation was identified at the beginning of reduction, without hemodynamic instability. Six children (5.8%) underwent either open (n=4) or laparoscopic surgery (n=2) for reduction failure. CONCLUSION: The median delay between diagnosis and initiation of reduction at this paediatric hospital was short, especially among patients transferred with a suspicion of intussusception and children with intravenous access prior to diagnosis. Complications from pneumatic reduction were infrequent.

Impact of overweight/obesity on clinical outcomes after reduction for intussusception in children.

PURPOSE: Childhood obesity is a worsening epidemic. Little is known about the impact of overweight and obesity (OV-OB) on clinical outcomes after reduction for intussusception in children. The aim of this study was to compare clinical outcomes after primarily air enema reduction for intussusception in grouped OV-OB (body mass index-for-age percentile ≥ 85) pediatric patients compared with no OV-OB patients. METHODS: A retrospective study of 564 children who had undergone intussusception reduction via pneumatic reduction (PR) from April 2018 to January 2020 was conducted with assessments of demographic data, clinical symptoms, pre-reduction examination, and reduction results. One-to-one propensity score matching (PSM) was performed to compare clinical outcomes between patients with and without OV-OB, and the risk factors affecting recurrence and surgical reduction were analyzed in the PSM population. RESULTS: Of the 564 patients, 132 cases (23.4%) were OV-OB (overweight: 95 cases; obesity: 37 cases). In the propensity-matched analysis, the OV-OB group showed a significant increase in surgical reduction (10.2% versus 0.9%, P = 0.005) and recurrence (47.2% versus 10.2%, P < 0.001), excretion time of carbon powder after PR (median: 11.2 h versus 8.4 h, P < 0.001), higher maximum pressure of PR (median: 10.2 kPa versus 7.8 kPa, P < 0.001), and number of PR attempts (mean: 2.0 versus 1.4, P < 0.001). There were no significant differences in the reasons for surgery (PR failure or bowel perforation), time to recurrence (early or late), and the times of recurrences ≥ 2. After applying the multivariate logistic regression analysis, we found that OV-OB and white blood cell count ≥ 20 × 109/L were risk factors for both surgical reduction and the recurrence of intussusception. CONCLUSION: This study suggested that childhood OV-OB was associated with the failure of PR and recurrence of intussusception after reduction, which should be paid more attention in clinical practice.

Factors Associated with Failure of Pneumatic Reduction in Children with Ileocolic Intussusception.

Intussusception is one of the most common causes of intestinal obstruction in children. Pneumatic reduction is the treatment of choice and has a high success rate. The most common cause of pneumatic reduction failure is the presence of a pathological leading point. We aimed to identify other factors that can lead to pneumatic reduction failure in children with ileocolic intussusception. This was a retrospective study conducted in two centers. Data were collected from January 2013 to December 2014. A total of 156 patients were diagnosed with intussusception and underwent pneumatic reduction, with the exception of one patient with peritonitis. We included patients with ileocolic-type intussusception without apparent pathological leading points. Logistic regression analysis of clinical parameters was performed to identify factors associated with pneumatic reduction failure. Of 156 patients diagnosed with intussusception in both hospitals, 145 were enrolled in the study. The overall efficacy of pneumatic reduction was 85.7%, and surgical reduction was performed in 21 patients. Univariate analysis showed that a high segmented neutrophil count, low hemoglobin level, high body temperature, and higher weight percentile were associated with pneumatic reduction failure. Multivariate analysis showed that a high segmented neutrophil count, low hemoglobin level, and higher weight percentile were significantly associated with pneumatic reduction failure. Pneumatic reduction is safe and effective as a first-line treatment for pediatric intussusception. However, a high segmented neutrophil count, low hemoglobin level, and higher weight percentile are associated with the failure of this treatment.

Treatment Outcome of Acute Intussusception in Children Under Two Years of Age: A Prospective Cohort Study.

Background Intussusception is a common cause of small intestinal obstruction in children under two years of age. Late diagnosis can lead to a potentially worse condition. This prospective study aims to describe the clinical manifestation and develop a conservative management protocol for acute ileocaecal intussusception in children under two years of age. Methods This prospective study was carried out in 118 consecutive patients under two years of age. Patients presented with symptoms and signs of acute intestinal obstruction and a diagnosis of ileocaecal intussusception confirmed by ultrasound were included in this study. All the patients were managed with either pneumatic reduction or operation. Results There were 70 boys and 48 girls ranging in age from three months to two years with a median of 12.5 months. Clinical presentation included abdominal pain (100%), vomiting (82.2%), bloody stool (11.9%), and a palpable mass (43.2%). Patients hospitalized with the symptoms and signs for less than 24 hours accounted for 80.5% of the cases. The overall success rate of pneumatic reduction was 98.3%. Late hospital admission (≥ 24 hours from illness onset), bloody stool, and presenting with the classic triad of symptoms of intussusception were found as the factors that correlated to the surgical management outcome. All patients recovered well without any complications. The median of postoperative hospital stay of two days for the pneumatic reduction group and six days for the operation group. Conclusion The early diagnosis of intussusception contributes to the success of pneumatic reduction and reduces the requirement of surgical intervention.

Selection of Pneumatic Reduction in Invagination Treatment and the Factors Affecting the Success of This Method.

Objective To retrospectively evaluate the success rates of fluoroscopy-guided pneumatic reduction in children with intussusception and to determine the risk factors and patient characteristics affecting the success of this method. Materials and methods Retrospective evaluation was made of a total of 183 children diagnosed with ultrasonography (USG) and treated in the pediatric surgery clinic between August 2010 and December 2017. Data related to gender, age (month), date of presentation, invaginated segment localizations and treatment modalities were retrieved from the patient files. In children who underwent pneumatic reduction, surgical success was determined as the visualization of air flow through the small intestine on fluoroscopy and patients who received reduction were followed up in our clinic. No progress of the air given or failure to see the air flow to the small intestine despite some progression of the air was evaluated as failure and surgical procedure was started in 39 patients. All patients were followed up at the hospital for at least 24 to 48 hours after the procedures. Patients with perforation, peritonitis, vital instability, or general condition disorder during presentation at our clinic (n = 29) were directly admitted for surgery. Results The study included a total of 183 children, comprising 116 (63.4%) males and 67 (36.6%) females with a mean age of 61.3 ± 34.3 months. While mesenteric lymphadenitis (n = 7) was determined as the most common lesion in cases where a pathologic lead point was detected (7.6%), Meckel's diverticulum was observed in four patients, polyps in two patients, and an involvement associated with Henoch Schönlein Vasculitis in one patient. Pneumatic reduction procedure was applied in 154 (84.1%) patients and successful results were obtained in 115 (74.7%) patients, while surgical intervention was required in 39 (25.3%) patients. While frequency of admission to direct surgery following the failure of pneumatic reduction in children under the age of two years was determined to be higher than the frequency of healing, the successful pneumatic reduction and admission to direct surgery rates in children between the ages of 0-4 years was found to be significantly higher than those in other age groups (p < 0.001). The pneumatic reduction success rate was determined to decrease significantly in children aged ≥6 years (p < 0.001). The mean hospitalization duration of the patients who underwent surgery after pneumatic reduction (five days) was determined to be significantly longer compared to that of the patients who underwent direct surgery and for whom a successful pneumatic reduction was ensured (p = 0.001 and p = 0.008, respectively). Conclusion Fluoroscopy-guided pneumatic reduction has a high success rate and is still one of the first option methods in the treatment of idiopathic intussusception. The application of the method under operating room conditions is more appropriate for patient safety. It is considered that the non-operative reduction success may increase with the detailed evaluation of intussusception cases determined to have pathologic lead points in children aged <2 years and >6 years.

Intussusception in children: lessons learned from intestinal lymphoma as a rare lead-point.

BACKGROUND: Most cases of intussusception in children are idiopathic. Rarely, a malignant disease such as intestinal lymphoma may cause intussusception. Due to dramatic changes of expected outcome with chemotherapy regime alone, the surgical management of patients with intestinal lymphoma presenting with intussusception has to be reevaluated. METHODS: Retrospective chart review from May 2011 to February 2017. We included all patients with intestinal lymphoma presenting with intussusception. RESULTS: We found five patients with a mean age of 6.4 years (range 3-16). The most common presenting symptom was abdominal pain for several weeks which had acutely worsened. In all but one patient an ultrasound before pneumatic or hydrostatic reduction showed a finding suspicious of a pathological lead-point. Pneumatic or hydrostatic reduction was attempted in all patients, no complications were noted. In one patient reduction was not successful. Recurrence after reduction occurred in two patients. Two patients needed surgery, three had a percutaneous ultrasound-guided biopsy for diagnostic purposes. All patients had aggressive mature B cell non-Hodgkin lymphoma. CONCLUSION: A high index of suspicion for the presence of a pathological lead-point in children older than 4 years and children with recurrent intussusception is necessary in patients presenting with intussusception. Malignant, highly aggressive B cell non-Hodgkin lymphoma, although rare, must actively be searched for. Pneumatic or hydrostatic reduction should remain the first line treatment in most cases.

Pediatric intussusception and early discharge after pneumatic reduction.

OBJECTIVE: The success of non-operative reduction methods is extremely high in pediatric intussusceptions. Recurrent intussusceptions are also well-known entities in the pediatric age group after non-operative and operative reduction. Historical recommendations include a 24- to 48-h observation period after reduction. This situation often leads to unnecessary time loss. We aimed to show that early discharge does not pose a significant risk. METHODS: The medical records of patients who presented to our hospital between January 2008 and June 2017 were retrospectively reviewed. Data collected included age, clinical presentation, procedural information, surgical intervention, hospital stay, and presence of recurrence. RESULTS: A total of 62 patients were included the study. Non-operative reduction was successful in 58 of 62 patients (93.5%). Four patients with failed non-operative reduction underwent subsequent surgical procedures. All patients were allowed oral intake within 2-4 h (mean: 2.6 h) after successful non-operative reduction and discharged within 5-8 h (mean: 6.2 h) after reduction. There were five episodes of recurrence and none occurred in the first 48 h after reduction. All recurrences were treated with non-operative reduction as in the first attempt. There were no problems detected in short- or long-term follow-ups. CONCLUSION: Pneumatic reduction is a safe and effective method in pediatric intussusception. If one is confident about treatment success, patients can be discharged without a long observation period. Early discharge is also cost-effective and reduces time loss.

A randomized trial of pneumatic reduction versus hydrostatic reduction for intussusception in pediatric patients.

OBJECTIVES: Data of randomly controlled trials comparing the hydrostatic and pneumatic reduction for intussusception in pediatric patients as initial therapy are lacking. The aim of this study was to conduct a randomly controlled trial to compare the effectiveness and safety of the hydrostatic and pneumatic reduction techniques. STUDY DESIGN: All intussusception patients who visited West China Hospital of Sichuan University from January 2014 to December 2015 were enrolled in this study in which they underwent pneumatic reduction or hydrostatic reduction. Patients were randomized into ultrasound-guided hydrostatic or X-ray-guided pneumatic reduction group. The data collected includes demographic data, symptoms, signs, and investigations. The primary outcome of the study was the success rate of reduction. And the secondary outcomes of the study were the rates of intestinal perforations and recurrence. RESULTS: A total of 124 children with intussusception who had met the inclusion criteria were enrolled. The overall success rate of this study was 90.32%. Univariable analysis showed that the success rate of hydrostatic reduction with normal saline (96.77%) was significantly higher than that of pneumatic reduction with air (83.87%) (p=0.015). Perforation after reduction was found in only one of the pneumatic reduction group. The recurrence rate of intussusception in the hydrostatic reduction group was 4.84% compared with 3.23% of pneumatic reduction group. CONCLUSION: Our study found that ultrasound-guided hydrostatic reduction is a simple, safe and effective nonoperative treatment for pediatric patients suffering from intussusceptions, and should be firstly adopted in the treatment of qualified patients. LEVEL OF EVIDENCE: Therapeutic study TYPE OF STUDY: Prospective study.

PNEUMATIC REDUCTION OF INTUSSUSCEPTION IN CHILDREN: EXPERIENCE AND ANALYSIS OF OUTCOME AT JUTH, JOS, A TERTIARY HEALTH CENTRE IN NORTH CENTRAL NIGERIA.

CONTEXT: Intussusception is a common childhood abdominal surgical emergency worldwide resulting in considerable morbidity and mortality if not promptly treated. Ultrasound-guided pneumatic reduction has been proven to be the most reliable and successful non-operative management option with the least complication rate. AIMS: To evaluate our local experience with the ultrasound-confirmed pneumatic reduction of childhood intussusception and to determine factors that predict successful outcome. SETTINGS AND DESIGN: A retrospective study of children less than 2 years old who presented to our facility with uncomplicated idiopathic intussusceptions between June, 2012 and June, 2017. MATERIALS AND METHODS: The clinical diagnosis was confirmed by abdominal ultrasonography. Pneumatic reduction with a locally assembled equipment was performed on selected and resuscitated patients; abdominal ultrasound scan was then performed to confirm successful reduction. The procedure was considered to have failed if unsuccessful after the third attempt. Laparotomy was performed on patients with failed procedure. STATISTICAL ANALYSIS USED: Statistical Package for Social Sciences version 24 was used for data analysis. Categorical variables were compared using Fisher exact test (with odds ratios and 95% confidence intervals where appropriate) and numeric variables compared using the student t-test. Statistical significance was set at p< 0.05. RESULTS: Twenty five out of 36 children with intussusception were selected for the procedure with M:F ratio 1.8:1 and a mean age of 7.08 (SD 4.18) months. Only 9 (36%) presented early (ie within 24 hours). While non-bilious vomiting was the commonest symptom, blood-stained finger on rectal examination was the commonest sign in the patients. The overall success rate was 60% (15 patients). Early presentation accounted for only 5 (33%) of successful procedures. The presence of an abdominal mass was associated with increased likelihood of success (OR 9.75,[95% CI [1.38-68.78], p≥0.022), while the presence of a rectal mass was associated with a reduced likelihood of success (OR 0.16 95%CI [0.026-0.917], p≥0.042 ). Age, sex, and duration of symptoms before presentation did not influence outcome. Early presentation was however significantly associated with success at first attempt, compared to late presentation, in those with successful outcomes. Recurrence was observed in one (6.7%) of the successful cases. The mean duration of hospital stay in those that had successful outcome, 3.4(SD1.0) days was significantly shorter than that for those who had laparotomy for failed reduction, 8.0(SD3.1) days (p<0.001). There was no bowel perforation and no mortality recorded. CONCLUSIONS: The successful pneumatic reduction rate was 60%. The major predictors of success in this study were the presence of abdominal mass and the absence of intussusception apex in the rectum. Early presentation was significantly associated with success at first attempt, compared to late presentation, in those with successful outcomes. There was no bowel perforation or mortality. Ultrasound-confirmed pneumatic reduction of intussusception is a simple, easy, safe and effective non-operative management of uncomplicated intussusception in well selected children in our environment.

Lower Gastrointestinal Bleeding & Intussusception.

Relatively uncommon compared with the adult population, lower gastrointestinal bleeding in children requires expeditious evaluation and management because of the variety of causes ranging from benign to life-threatening conditions. The causes of lower gastrointestinal bleeding (LGIB) vary with patient age. This review focuses on the differential diagnosis and management of LGIB in children. Because intussusception is one of the most common sources of LGIB, particular attention will be given to its diagnosis and management.

Prognostic indicators for failed nonsurgical reduction of intussusception.

PURPOSE: To identify the risk factors for failure of nonsurgical reduction of intussusception. METHODS: Data from intussusception patients who were treated with nonsurgical reduction in Chiang Mai University Hospital and Siriraj Hospital between January 2006 and December 2012 were collected. Patients aged 0-15 years and without contraindications (peritonitis, abdominal X-ray signs of perforation, and/or hemodynamic instability) were included for nonsurgical reduction. The success and failure groups were divided according to the results of the reduction. Prognostic indicators for failed reduction were identified by using generalized linear model for exponential risk regression. The risk ratio (RR) was used to report each factor. RESULTS: One hundred and ninety cases of intussusception were enrolled. Twenty cases were excluded due to contraindications. A total of 170 cases of intussusception were included for the final analysis. The significant risk factors for reduction failure clustered by an age of 3 years were weight <12 kg (RR =1.48, P=0.004), symptom duration >3 days (RR =1.26, P<0.001), vomiting (RR =1.63, P<0.001), rectal bleeding (RR =1.50, P<0.001), abdominal distension (RR =1.60, P=0.003), temperature >37.8°C (RR =1.51, P<0.001), palpable abdominal mass (RR =1.26, P<0.001), location of mass (left over right side) (RR =1.48, P<0.001), poor prognostic signs on ultrasound scans (RR =1.35, P<0.001), and method of reduction (hydrostatic over pneumatic) (RR =1.34, P=0.023). The prediction ability of this model was 82.21% as assessed from the area under the receiver operating characteristic curve. CONCLUSION: The identified prognostic factors for the nonsurgical reduction failure may help to predict the reduction outcome and provide information to the parents.

Enema reduction of intussusception: the success rate of hydrostatic and pneumatic reduction.

PURPOSE: 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). CONCLUSION: 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.

Invaginación intestinal recurrente secundaria a apéndice cecal invaginado: caso clínico / Recurrent intussusception secondary to invaginated cecal appendix. Case report

Introducción: La invaginación intestinal es una patología de causa idiopática en el 95 por ciento de los casos, encontrándose en el 5 por ciento restante algún factor desencadenante que la justifique. Las recurrencias se presentan en un 7 a 12 por ciento de los casos y se asocian a múltiples causas. El objetivo de este trabajo es presentar el caso de un paciente con invaginación intestinal recurrente y analizar la causa de la recurrencia. Caso clínico: Paciente de 1 año y 4 meses de edad, sexo masculino, con antecedente de primer episodio de Invaginación intestinal operado a los 4 meses de edad. Presenta segundo episodio de invaginación a los 9 meses de edad, la cual se trató con desinvaginación neumática y a los 16 meses de edad presentó su tercer episodio, manejandose con desinvaginación hidrostática. Ocho horas post procedimiento el paciente presentó nueva invaginación; se realizó reducción manual quirúrgica. Se encontró una invaginación ileocólica con un remanente apendicular intracecal actuando como cabeza invaginante. Se reseco remanente y se envió a biopsia. Conclusiones: La invaginación intestinal recurrente se asocia a factores anatómicos desencadenantes, por lo cual al presentar recurrencias se debe tener en consideración una posible causa orgánica, ante lo cual se recomienda el tratamiento quirúrgico.

Introduction: Intussusception is an idiopathic pathology that accounts for 95 percent of cases found; the remaining 5 percent is caused by some triggering events. Recurrences occur in 7 to 12 percent of cases and are associated with multiple causes. The aim of this research is to present the case of a patient with recurrent intussusception and analyze the cause of the recurrence. Case report: The patient was a 16 month-old male infant with a history of first episode of intussusception surgery at 4 months old. His second intussusception episode took place at 9 months of age, which was treated with pneumatic reduction process; at 16 months of age he presented his third episode, which was treated with hydrostatic reduction process. 8 hours post procedure, the patient had a new intussusception condition and surgical manual reduction was performed. Ileocolic intussusception was found with an appendiceal intrathecal remnant acting as the invaginating head. Remnant was removed and sent for biopsy. Conclusions: Recurrent intussusception is associated with triggering anatomical factors; therefore, in the case of recurrences, a possible organic cause should be considered and surgical treatment is recommended.

An air insufflation device for reduction of intussusception in children.

The authors have developed a portable device for insufflation of air reliably at pressures accepted as safe for effective reduction of intussusception in children under fluoroscopic guidance. The results of reduction with the device were equal to those by saline enema reduction under ultrasound guidance.

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.