Pneumatic Reduction of Paediatric Intussusception: Clinical Experience and Factors Affecting Outcome
P Tang, EKC Law, WCW Chu
Hong Kong J Radiol 2016;19:200-7
DOI: 10.12809/hkjr1615390
Objectives: To determine the success rate of pneumatic reduction of intussusception, and to identify factors that predict an unsuccessful outcome among Chinese paediatric patients in Hong Kong.
Methods: This retrospective study assessed data from Chinese paediatric patients with suspected intussusception who underwent fluoroscopy-guided pneumatic reduction at a tertiary institute in Hong Kong from January 2008 to December 2014. Pneumatic reduction of 152 intussusceptions was attempted in 137 patients (79 male, 58 female). Presenting signs and symptoms, results of radiological investigations, the outcome of attempted reduction, complications, and any subsequent surgical intervention were examined.
Results: Successful reduction was achieved in 115 (83.9%) cases during the study period. The mean age at presentation was 11.5 months (range, 2 months to 4.5 years). Only one (0.7%) case was complicated by perforation and 13 (9.5%) cases by early recurrence. Several predictors of failure were found, including: (a) long duration of symptoms (p < 0.001); (b) bleeding per rectum (p < 0.01); (c) evidence of small bowel obstruction at the time of presentation (p < 0.05). Among the 22 cases of failed reduction, surgery was performed and the findings were colocolic intussusception (n = 4), ileo-ileo-colic intussusception (n = 3), perforated ischaemic colon during pneumatic reduction (n = 1), and ileocolic intussusception (n =14). Six (4.4%) patients had lead points. Partial small bowel resection was required in seven (5.1%) cases for non-viable bowel. No deaths were recorded during the study period.
Conclusion: Fluoroscopy-guided pneumatic reduction of intussusception offers a high success rate (83.9%) with few complications, and our institution’s radiological reduction outcomes were comparable with international standards. The most important predictor of outcome in this study was the long duration of symptoms.
中文摘要
為腸套疊小兒患者實施空氣灌腸復位術：臨床經驗及影響結果的因素
鄧蕙碧、羅嘉齊、朱昭穎
目的：確定香港小兒患者中使用降低腸腔內壓力來治理腸套疊的成功率，並找出未能成功的因素。
方法：本研究回顧2008年1月至2014年12月期間於香港一所機構中進行腸套疊透視下空氣灌腸復位的腸套疊小兒患者的數據。137名（79男，58女）患者進行了152次腸套疊透視下空氣灌腸復位術。研究資料包括：患者症狀和體徵、影像學結果、復位術結果、併發症和其他後續手術干預。
結果：研究期間成功進行腸套疊透視下空氣灌腸復位術的有115例（83.9%）。患者的病發年齡平均為11.5個月（介乎2個月至4.5歲）。只有1例（0.7%）伴有穿孔的併發，另13例（9.5%）有提早復發的情況。預測腸套疊透視下空氣灌腸復位術未能成功的因素包括：（1）症狀持續時間長（p<0.001）；（2）直腸出血（p<0.01）；（3）病發時有小腸梗阻（p<0.05）。22個未能成功的病例均接受手術，發現有4例屬大腸腸套疊、3例迴腸－迴腸－結腸型腸套疊、1例進行透視灌腸復位術期間出現穿孔性缺血性結腸和14例小腸腸套疊。6名患者（4.4%）有引導病灶。7例（5.1%）不能排便的須切除部分小腸。研究期間並無死亡紀錄。
結論：腸套疊透視下空氣灌腸復位具有高成功率（83.9%），併發症少。本院的放射性腸套疊透視下空氣灌腸復位結果與國際標準相當。本研究發現腸套疊透視灌腸復位最重要的預測因素是症狀持續時間長。