SONOGRAPHICALLY GUIDED HYDROSTATIC REDUCTION OF CHILDHOOD INTUSSUSCEPTION IN UTTARADIT HOSPITAL

Abstract

Over 10-year period, real-time ultrasound (US) were performed in 33 intussusceptions (32 cases). 21 cases were undergone immediate reduction procedure after the diagnosis. The reductions were performed under US-guided using normal saline as enema fluid under pressure control of 80-110 mmHg. The height of the enema bag is about 3 feet above the table top as usual. 4 cases were successfully reduced. Complete reductions could not be confirmed in another 3 cases but follow up revealed complete recovery. 14 cases were operated. 12/14 operated cases underwent manual reductions and 2/14 got bowel resections. Surgical findings were as followed: 1 gangrenous bowel,1 polyp in the terminal ileum,1 inflamed appendix, 3 ileo-ileocolic intussusceptions, 3 ischemic changes, 4 long intussusceptions, 4 small residual intussusceptions and 1 negative for intussusception (more than one findings in one case).

Success rate of reduction is 19.05% (n=21). Factors influencing incomplete reductions were poor general conditions, massive rectal bleeding, small bowel obstruction and rectal-sealed problem.

Potential improvement can be made to achieve better result. The seal problem can be avoided by inflation of the Foley's balloon and controlling the reduction time not longer than 15 minutes. The poor general conditions should be improved prior reduction attempted. Although this method has not yet been shown to be as good as those conventional ones, the obvious benefits are radiation free effect and being more friendly to the atmosphere. Sonogram is operator dependent and the US-guided saline enema reduction needs time for learning curve to become more accepted procedure.