Ultrasound guided reduction of intussusception with saline and comparison with operative treatment.

ABSTRACT

BACKGROUND: Reduction of intussusception under ultrasound guidance by saline has become popular in recent years. However, methods, duration of the procedure and causes of failure are not defined. In this study, we reviewed the patients who underwent ultrasound (US) guided saline reduction and compared them with those who were previously managed by operative intervention. METHODS: Patients with severe peritonitis or perforation, those over 3 years or younger than 1 month were excluded. Saline was applied by anus. Entry of saline into the ileum was the main indicator for successful reduction. Dramatic improvement in the clinical findings was considered as an additional sign of successful reduction. No limit was imposed on duration of the procedure. RESULTS: Hydrostatic reduction was successful in 41 out of 51 patients with intussusception. In three patients with partial resolution, hydrostatic reduction was attempted later and total reduction was achieved. No perforation or other complications were seen. In ten cases with reduction failure, one had an ileal lymphoma and another one had a duplication cyst as lead points. CONCLUSION: US guided hydrostatic reduction for childhood ileocolic intussusception is safe and, painless, has a high success rate and avoids radiation exposure risk. Presence of ultrasonographic and clinical changes is the best indicator of a successful reduction. In some cases, a second attempt may be necessary for reduction.