Pneumatic Reduction of Paediatric Intussusception: Clinical Experience and Factors Affecting Outcome

Full Article

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.