Childhood intussusception: a comparative study of nonsurgical management.

PURPOSE

A prospective study was conducted comparing air reduction, barium reduction under fluoroscopy, and saline reduction under ultrasound guidance for diagnosis and treatment of intussusception involved in 147 patients.

METHODS

Fifty children received air reduction (AR group), 50 received barium enema reduction (BE group) and 47 received saline reduction under ultrasound guidance (US group). Nonoperative management was attempted if there was a history of less than 48 hours; absence of general or abdominal signs of toxicity, peritonism, or peritonitis, and reasonable blood electrolyte levels (K, 3 to 5 mmol/L; Na, 130 to 150 mmol/L).

RESULTS

Group AR had successful outcome in 45 of 50 children (90%); BE had successful outcome in 35 of 50 children (70%), and US had successful outcome in 32 of 47 children (67%). This 20% to 23% success rate difference between air reduction and the other two techniques (BE and US) was statistically significant (P = .01). There was no significant difference between BE and US saline (P > or = .05). There were no perforations encountered in AR patients, three perforations in BE patients, and two perforations in US patients. There was no mortality.

CONCLUSIONS

Air reduction seems to be associated with fewer complications and the highest success rate. Proper selection of patients is crucial to achieve a high success rate and to minimise complications.