A REVIEW OF ULTRASOUND-GUIDED PNEUMATIC ENEMA IN THE REDUCTION OF INTUSSUSCEPTION IN CHILDREN: INSIGHTS FROM A TEACHING HOSPITAL IN NIGERIA

Abstract

Background: Pneumatic reduction, as a non-operative mode of treating intussusception, is traditionally done under fluoroscopy guidance. However, fluoroscopy guidance is fraught with exposure to ionizing radiation and fluoroscopy machines may not be routinely available especially in low-and-middle-income countries. The aim of this study was to evaluate the efficacy, safety and predictive factors of successful reduction of intussusception using the ultrasound-guided pneumatic technique.

Materials & methods: This was a prospective cohort study of children, 3 to 36 months of age, who were confirmed to have intussusception by abdominal ultrasonography and had pneumatic (air) reduction under ultrasound guidance between December 2018 to December 2020. Patients with bowel perforation, peritonitis, non-responsive shock or recurrent intussusception were excluded. Success rate, time to reduction, complication (recurrence and perforation) rate, and predictive factors for successful reduction were evaluated.

Results: Thirty (36.1%) out of 83 patients who presented with intussusception during this period had ultrasound-guided pneumatic reduction. The mean age was 6.1±1.6 (range: 4 to 9) months. Male to female ratio was 2.3:1. About one-third of the patients presented within ≤48 hours of onset of symptoms. 21 patients (70%) had a successful reduction. The mean time to reduction was 10.51 ± 4.19 (range: 3 to 16) minutes. One patient had recurrence giving a recurrence rate of 3.3%. There was no case of perforation. Patients who had successful reduction significantly had palpable abdominal mass (p = 0.0139), serum sodium >135mmol/l (p = 0.0419) and serum potassium >3.5mmol/l (p = 0.0318). Only serum potassium >3.5mmol/l (Odd ratio (OR), 6.9; 95% confidence interval (CI), 1.2 - 40.3; p = 0.03) was significantly associated with successful reduction on multivariable analysis.

Conclusion: Ultrasound-guided pneumatic reduction of ileocolic intussusception is feasible, effective and safe. It may be used in the treatment of children who present with ileocolic intussusception. Serum potassium >3.5mmol/l may suggest the likelihood of successful reduction.

Keywords: Children; Intussusception; Pneumatic reduction; Ultrasound-guided.