Predictors of Failure in Ultrasound-Guided Hydrostatic Reduction of Intussusception in Children: Retrospective Analysis in a Specialized Center in Ethiopia

Abstract

Purpose

To identify factors predicting the failure of ultrasound-guided hydrostatic reduction of intussusception in children.

Patients and Methods

The medical records of 174 children who underwent ultrasound-guided hydrostatic reduction of intussusception over four years were reviewed at Tikur Anbessa Specialized Hospital. Patient’s demography, clinical data, and sonography findings (type of intussusception, length of intussusception, presence of lead point, trapped fluid, lymph node, and free peritoneal fluid) were entered into SPSS 25 (IBM) and analyzed using logistic regression.

Results

The overall success rate of ultrasound-guided hydrostatic reduction was 81.6%. The sex, presence of abdominal cramps, vomiting, diarrhea, trapped lymph nodes on ultrasound, or history of upper respiratory tract infection had no association with hydrostatic reducibility. Currant jelly stool (OR 0.128; 95% CI, 0.27–0.616; P=0.01), Ileo-ileo colic intussusception (OR 0.055; 95% CI, 0.005–0.597; P=0.017), pathologic lead point (OR 0.66; 95% CI, 0.01–0.447; P=0.005) and abdominal distention (OR 0.209; 95% CI, 0.044–0.998; P=0.048) showed significant association with failed hydrostatic reduction.

Conclusion

The presence of currant jelly stool, ileo-ileo colic type intussusception, pathologic lead point, and abdominal distention are the most important predictors for failed ultrasound ultrasound-guided reduction intussusception in children.

Plain Language Summary

Intussusception occurs when an upper part of the bowel invaginate into the lower adjacent segment. Usually, the small intestine slides into the wider large intestine. It is the common cause of gut obstruction in children below 3 years of age. It occurs in 2 out of 1000 children, and the cause is not known in 95% of the cases.

Most of the children are treated without surgery. If left untreated may complicate life-threatening conditions. The non-surgical management is feasible in a child who is not critical. It is achieved by putting air or suitable fluids under pressure through a tube to the rectum. The fluid in the rectum flows to the intestine creating a pressure that pushes back the invaginated intestine to its normal position. The reduction is followed by an ultrasound of the belly. Currently, this technique is widely practiced with reasonable success rates.

In some children, the reduction with this technique may fail due to different conditions. So, our study was aimed at identifying the possible factors that are responsible for the failure of reduction. The success rate of reduction during our study period was 81.6% (144/176). This study has identified that in children with blood-mixed mucous in stool during illness, the Presence of belly distention, and the presence of known causes of intussusception detected by ultrasound during the examination of the child significantly contributed to failure of non-surgical reduction.

Keywords:

• pediatric intestinal obstruction
• idiopathic intussusception
• pediatric ultrasound
• saline enema

Data Sharing Statement

The data used during the study are available from the corresponding.

Ethics Approval and Informed Consent

All methods were carried out per the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments for which reason. The study approval was obtained from the institutional review board of Addis Ababa University College of Health Sciences School of Medicine. Because of the retrospective nature of the study, the need for consent to participate was waived by the same committee and patient data confidentiality was maintained throughout the study.

Acknowledgments

We would like to thank the administrators of the College and the hospital staff for allowing us to access the patients’ charts. We would like to extend our thanks to Pediatric Surgery and Radiology residents for helping us to collect a list of patients from the operation registry books and more importantly to Patient Record Office workers for their genuine effort during patient chart searching.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published on the Pediatric Health, Medicine and Therapeutics; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that the research was conducted in the absence of any conflicts of interest.

Additional information

Funding

The authors receive no financial support for any gain.