Utility of hospital admission after successful enema reduction of ileocolic intussusception.

BACKGROUND: In-hospital observation of 24 to 48 hours has been the standard practice after successful enema reduction (ER) of ileocolic intussusceptions, but this practice has not been validated. We evaluated retrospectively the safety of short-term emergency department observation. METHODS: Between April 2000 and October 2004, 121 patients presented to the emergency department with ileocolic intussusception, and all had ER attempts. RESULTS: Ninety-six patients had successful reduction, 25 were excluded for failed reduction or unconfirmed diagnosis, and another 16 needed observation anyway for high white blood count or persistent postreduction pain. Of the remaining 80 patients, the mean time from symptoms to reduction was 45.9 hours (4 hours to 10 days). All patients, except one, were admitted for observation for a mean period of 1.6 days (8 hours to 6.5 days). No complications were associated with air ER; however, 6 (7.5%) patients had reintussusception during the observation period and 5 (6.3%) recurred after discharge. The mean intervals for recurrence postreduction were 17.8 hours and 14.5 months with no mortality or morbidity in either. CONCLUSIONS: Short-term emergency department observation could be a safe practice in more than 90% of the selected cases, recurrence of intussusception outside the hospital is not associated with unfavorable outcome, and routine admission is not warranted.

Fetal hydronephrosis: is there hope for consensus?

This review article aims at summarizing the data regarding fetal and neonatal hydronephrosis, at correlating controversial data with the differences in the practice of obstetrical sonography from one country to another, and finally, at presenting our own criteria for fetal renal collecting system dilatation along with our own guidelines of postnatal investigation.