Hydrostatic reduction of intussusception with intermittent radiography: an alternative to fluoroscopy or ultrasound-guided reduction in low-income and middle-income countries

Abstract

Background: Although hydrostatic reduction of intussusception with ultrasound (US) or fluoroscopy guidance is well known, it is not yet well established in many low-income and middle-income countries. The aim of the study is to report our results of hydrostatic reduction with intermittent radiography, which has the potential to be practiced in resource-limited settings.

Methods: We retrospectively analyzed our patients with intussusception from 2009 to 2019 (11 years). Hydrostatic reduction was performed using water-soluble contrast medium (iopamidol), and reduction was followed with intermittent X-rays taken after every 50 mL of diluted contrast injection. The procedure was not continuously monitored by US or fluoroscopy. Differences in outcome based on age and gender, and yearly trends of admission for intussusception, types of treatment and mortality were analyzed.

Results: Among 672 patients, the ratio of boys to girls was 2.46:1.0, and their ages ranged from 1 month to 15 years (median 8 months). Hydrostatic reduction was performed successfully in 351 (52.23%) patients; 308 (45.83%) patients underwent surgery; and 13 (1.93%) patients died before any intervention. There were significant differences in age between patients with successful hydrostatic reduction (median 7 months) and patients needing surgery (median 9 months) (p<0.001). The number of successful hydrostatic reductions increased during the 11 years of the study (R²=0.88). One patient (0.15%) died after hydrostatic reduction, and 10 (1.49%) died after surgery.

Conclusion: Hydrostatic reduction with intermittent radiography was performed successfully in more than half of the patients with acceptable complication rates.

Keywords: child health; health services; hospitals; pediatric; pediatrics.

Figure 1

Yearly numbers and percentages of intussusception admissions (n=672). (A) Gradually increasing trendline of total yearly admissions for intussusception. (B) Yearly percentage for intussusception admissions among all admissions also increased gradually.

Figure 2

Types of treatment for intussusception during the total study period (2009–2019), n=672.

Figure 3

Frequency and percentage of different types of treatment modalities during the total study period (n=672). (A) Yearly frequencies and (B) yearly percentages of treatment modalities.

Figure 4

Yearly frequency and percentage of deaths from intussusceptions during the total study period (n=24).