Protocolized management of intussusception in children: optimizing pneumatic reduction outcomes

Abstract

Background: Intussusception is the most common cause of intestinal obstruction in children, requiring timely management to avoid serious complications. Pneumatic reduction is widely accepted as the first-line non-operative treatment, though its success may be influenced by factors such as prolonged symptom duration, intussusception type, and advanced intussusceptum location. The role of adjunct therapies, including corticosteroids, remains uncertain. This study aimed to evaluate the outcomes of a standardized modified pneumatic reduction (MPR) protocol implemented at a single national pediatric center.

Materials and methods: A retrospective review was conducted of 92 admissions involving 79 patients treated between May 2016 and October 2024. The MPR protocol employed a manual sphygmomanometer-based system with incremental pressure adjustments and selective intravenous hydrocortisone for specific indications. Standardized documentation and follow-up protocols were applied.

Results: MPR achieved a 99% success rate, with complications limited to one case of pneumoperitoneum (1%) and self-limiting mild desaturation in 6% of cases. Early and delayed recurrence rates were 16 and 10%, respectively. Factors traditionally considered limiting did not preclude successful reduction. In the subgroup of failed attempts or recurrent cases, hydrocortisone use was associated with an increase in the proportion of 'easy' reductions from 47 to 83% (p = 0.038), suggesting a potential benefit warranting further investigation.

Conclusion: A structured, protocolized MPR approach resulted in high success and low complication rates, even in challenging scenarios. These findings support the value of standardized non-operative management and suggest a possible targeted role for hydrocortisone in selected cases.

Keywords: Air enema reduction; Hydrocortisone; Intussusception; Pneumatic reduction; Resource-limited settings.