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

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          Abstract

          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.

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          Most cited references 13

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          Acute intussusception in infants and children as an adverse event following immunization: case definition and guidelines of data collection, analysis, and presentation.

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            Intussusception. Part 2: An update on the evolution of management.

            Children with symptomatic ileocolic or ileo-ileocolic intussusceptions can be successfully managed in one of a number of different ways. The nonoperative enema reduction technique has major advantages over surgical reduction and high success rates can be achieved using pneumatic or hydrostatic reduction techniques under fluoroscopic or sonographic guidance. This article highlights current concepts and some controversial issues related to management of intussusception, including patient selection for attempted enema reduction, the advantages and disadvantages of each technique, complications, the value of delayed, repeated reduction attempts, the role of imaging after attempted enema reduction, and recurrence of intussusception.
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              Results of air pressure enema reduction of intussusception: 6,396 cases in 13 years.

               J. Guo,  X. Y. Ma,  Q Zhou (1986)
              Intussusception is the most common surgical emergency of childhood in China. Over the past 10 years, the incidence of intussusception has steadily increased world-wide, as well as in China. For example, 279 cases were treated in the Shanghai Children's Hospital in 1974, while 615 were treated in 1984. Twelve cases were treated in a course of a single night during 1985. Over the past 13 years, for which we have good records, 6,396 cases of intussusception were treated at the Shanghai Children's Hospital. Males outnumber females by a ratio of 2 to 1. In 3,872 cases seen over the past 6 years, 35.1% were under 6 months of age, 65.9% less than 1 year of age, and 88.4% less than 2 years of age.
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                Author and article information

                Journal
                Ther Clin Risk Manag
                Ther Clin Risk Manag
                Therapeutics and Clinical Risk Management
                Therapeutics and Clinical Risk Management
                Dove Medical Press
                1176-6336
                1178-203X
                2015
                15 December 2015
                : 11
                : 1837-1842
                Affiliations
                [1 ]Division of Pediatric Surgery, Department of Surgery, Chiang Mai University Hospital, Chiang Mai, Thailand
                [2 ]Division of Gastroenterology, Department of Pediatrics, Chiang Mai University Hospital, Chiang Mai, Thailand
                [3 ]Division of Pediatric Surgery, Department of Surgery, Siriraj Hospital, Mahidol University, Bangkok, Thailand
                [4 ]Division of Pediatric Surgery, Department of Surgery, Thammasat University Hospital, Pathumthani, Thailand
                [5 ]Center of Excellence in Applied Epidemiology, Thammasat University Hospital, Pathumthani, Thailand
                Author notes
                Correspondence: Jiraporn Khorana, Division of Pediatric Surgery, Department of Surgery, Chiang Mai University Hospital, Chiang Mai, Thailand, Tel +66 8 1992 9767, Email nanji22@ 123456gmail.com
                Article
                tcrm-11-1837
                10.2147/TCRM.S92169
                4687953
                © 2015 Khorana et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License

                The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                Categories
                Original Research

                Medicine

                success rate, intussusception, hydrostatic reduction, pneumatic reduction

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