Radu Stephanie, Lin Saunders, Le Louis D, Fialkowski Elizabeth, Zigman Andrew
School of Medicine, Oregon Health and Sciences University, Portland, Oregon.
Department of Surgery, Oregon Health and Sciences University, Portland, Oregon.
J Surg Res. 2022 Jul;275:109-114. doi: 10.1016/j.jss.2022.01.008. Epub 2022 Mar 5.
Ileocolic intussusception is a common cause of pediatric bowel obstruction. Contrast enema is successful in treating the majority of patients, and if initially unsuccessful, approximately one-third may be reduced with repeat enemas. We sought to study protocol implementation for delayed repeat enema in pediatric patients not reduced completely by an initial contrast enema. Our aims were to assess repeat enema success rates and outcome differences in preprotocol and postprotocol patients with respect to (1) intussusception recurrence, (2) surgical intervention and complication rates, and (3) length of stay.
We performed a retrospective review of treatment and clinical outcomes prior to and following protocol implementation for repeat enema for intussusception at two tertiary pediatric referral hospitals. The preprotocol period was defined from 2/2013 to 2/2016, and the postprotocol period was from 8/2016 to 11/2019.
There were 112 patients in the preprotocol group, with 74 (66%) having successful reduction following the first enema. Of the 38 patients without successful reduction, 16 (42%) patients underwent repeat enema, and five were successful (31%). The postprotocol group included 122 patients, with 84 (69%) having successful first reduction. Of the 38 patients that failed, 25 patients (66%) underwent repeat enema, of which 13 (52%) were successful. Compared to preprotocol patients, postprotocol patients had significantly more enemas repeated and a trend toward fewer surgical interventions.
Protocol implementation of repeat delayed enemas was significantly associated with an increased rate of repeat enemas at our institutions and reduced need for operative intervention during the index stay.
回结肠套叠是小儿肠梗阻的常见原因。造影灌肠成功治疗了大多数患者，若初次灌肠未成功，约三分之一的患者可通过重复灌肠复位。我们试图研究对初次造影灌肠未完全复位的小儿患者进行延迟重复灌肠的方案实施情况。我们的目的是评估重复灌肠成功率以及方案实施前后患者在以下方面的结局差异：（1）套叠复发；（2）手术干预和并发症发生率；（3）住院时间。
我们对两家三级儿科转诊医院实施套叠重复灌肠方案前后的治疗及临床结局进行了回顾性研究。方案实施前的时间段定义为2013年2月至2016年2月，方案实施后的时间段为2016年8月至2019年11月。
方案实施前组有112例患者，74例（66%）在首次灌肠后成功复位。在38例未成功复位的患者中，16例（42%）接受了重复灌肠，5例成功（31%）。方案实施后组包括122例患者，84例（69%）首次复位成功。在38例复位失败的患者中，25例（66%）接受了重复灌肠，其中13例（52%）成功。与方案实施前的患者相比，方案实施后的患者重复灌肠次数显著更多，且手术干预有减少的趋势。
在我们的机构中，实施重复延迟灌肠方案与重复灌肠率增加以及减少首次住院期间的手术干预需求显著相关。
