Pediatr Emerg Med J.  2024 Oct;11(4):147-153. 10.22470/pemj.2024.01081.

Multicenter comparison of non-operative techniques of intussusception reduction: saline versus air versus barium

• Srinivasan S
• Saroja MG
• Parelkar S
• Sanghvi B
• Shah R
• Radhakrishnan CN
• Rao RCS

• KMID: 2559547
• DOI: http://doi.org/10.22470/pemj.2024.01081

Abstract

Purpose
Intussusception is a common pediatric surgical emergency and non-operative reduction is its first line of management. We aimed to compare 3 contemporary techniques of intussusception reduction.
Methods
A retrospective study was performed in 3 tertiary care centers in India from January 2017 through December 2019. In the 3 centers, the primary reduction techniques were ultrasound-guided saline reduction (USR), fluoroscopy-guided pneumatic reduction (FPR), and fluoroscopy-guided barium reduction (FBR), respectively. As per these techniques used, we compared clinical characteristics, such as the successful reduction.
Results
A total of 255 patients underwent one of the 3 reduction techniques in the study period. Reduction was successful in 90.3%, 85.1%, and 87.7% in the USR, FPR, and FBR groups, respectively (P = 0.961). Mean time to reduction was shorter in the FPR group (30.8 ± 8.9 seconds), compared with the USR (575.0 ± 242.3 seconds) and FBR groups (495.0 ± 118.4 seconds; P < 0.001). Recurrence rates were 11.8%, 20.3%, and 15.8% in the USR, FPR, and FBR groups, respectively (P = 0.522). No association was found between the patients’ age or symptom duration and the successful reduction. One patient in the USR group, 3 in the FPR group, and 4 in the FBR group reported second recurrences. Perforation occurred in 1 patient in the FPR group while no complications occurred in the other groups. There was no in-hospital mortality.
Conclusion
All 3 techniques are equally effective, with FPR requiring a shorter time than the other 2 techniques. The reduction technique should be chosen based on the strengths and weaknesses of each technique, as well as local availability.

Keyword

Enema; Intestinal Obstruction; Intestinal Perforation; Intussusception; Hydrostatic Pressure; Barium Enema

Reference

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