Ultrasound guided reduction of an ileocolic intussusception by a hydrostatic method by using normal saline enema in paediatric patients: a study of 30 cases

Abstract

Introduction: The conventional hydrostatic reduction of an intussusception with barium enema or the pneumatic reduction of an intussusception is associated with considerable ionizing radiations and a risk of perforation; while the hydrostatic reduction of an intussusception under ultrasound guidance is a very safe method because the whole procedure is visualized with real time ultrasound. Also, being a non-invasive method with a high success rate, this procedure has emerged as a useful alternative to a surgical intervention.

Aim: The aim of this study was to evaluate the role of ultrasound and colour Doppler studies for the guidance of the hydrostatic reduction of a childhood intussusception by using normal saline.

Method: Among 41 children who were evaluated with ultrasonography for the confirmation of the presence of intussusceptions, hydrostatic reduction of intussusception were performed under a sonographic guidance in 30 patients, whereas 11 patients were excluded due to clinical contraindications.

Results: This disease was observed mostly at the ages of 6 months to 24 months. In 80% of the patients, there was a recent history of gastroenteritis and 40 % had a history of common cold. The most common site of the intussusception was the transverse colon near the hepatic flexor of the colon (90%), with a mean duration of 22.1±17.3 hours. The overall rate of a successful reduction was 87% and the mean reduction time was 14 minutes. None of the cases showed recurrence within 24 hrs. No complications were observed.

Conclusion: We conclude that ultrasound with colour Doppler study is very useful for the diagnosis of intussusceptions, as well as for guided hydrostatic reductions by using normal saline enema. This is an optimal, simple, and a safe procedure for the treatment of intussusceptions in paediatric patients.

Keywords: Colour Doppler study; Hydrostatic reduction; Intussusceptions; Ultrasound.

[Table/Fig-2]:

Complex mixed echogenic mass lesion of intussuscep- tions (white arrow). Fluid column is seen proximal to it (black arrows)

[Table/Fig-3]:

Ultrasound- T.S.-Target lesion of intussusceptions (open arrow) with few enlarged lymphnodes

[Table/Fig-4]:

Pseudokidney lesion with internal vascularity on Colour Doppler Study

[Table/Fig-6]:

Instillation of normal saline up to intussusception (arrows)

[Table/Fig-7]:

Reducing intussusceptum (arrow) with surrounding fluid filled loops (arrow heads)