Pediatric Radiology, Adventhealth Central Florida, Orlando, FL, USA.
Florida State University College of Medicine, Orlando, FL, USA.
Emerg Radiol. 2022 Dec;29(6):953-959. doi: 10.1007/s10140-022-02079-5. Epub 2022 Jul 30.
Ileocolic intussusception is considered a pediatric emergency, with concerns for risk of significant morbidity in children with a prolonged intussusception state. Emergent therapy is standard of care, as prior studies have shown poor outcomes in patients with long delays (> 24 h) before intervention. Various factors can result in shorter delays, and there are limited studies evaluating outcomes in these patients. This study aimed to determine if there were differences in reduction success rates associated with short in-hospital time delays.
This study is to determine enema success rate and morbidity in patients with documented time delays between intussusception diagnosis and therapeutic enema.
A retrospective evaluation of pediatric patients with intussusception at a single children's hospital between 2007 and 2019 was performed. Patient's records were reviewed for time of symptom onset, radiologic diagnosis, and attempted enema. Ultrasounds and radiographs were reviewed for bowel obstruction, free peritoneal fluid, trapped fluid around the intussusceptum, and absent bowel wall perfusion. Patients were evaluated for efficacy of reduction attempt, requirement for surgical reduction, and complications including bowel resection and bowel perforation.
There were 175 cases of ileocolic intussusception requiring enema reduction. Successful reduction occurred in 72.2% (13/18) of cases performed within 1 h of diagnosis; 74.3% (78/105) between 1 and3 h; 73.2% (30/41) between 3 and 6 h; and 81.2% (9/11) with greater than 6 h. Need for bowel resection was not associated with short delays between diagnosis and reduction attempts (p = .07).
There was no difference in intussusception reduction efficacy or complication rate in patients with increasing time between imaging diagnosis of ileocolic intussusception and reduction attempt, including delay intervals up to 8 h.
回肠-结肠型肠套叠被认为是儿科急症，对于肠套叠状态持续时间较长的儿童，存在发生严重发病率的风险。紧急治疗是标准的护理方法，因为之前的研究表明，在干预前有较长时间（>24 小时）延迟的患者预后较差。各种因素可能导致较短的延迟，并且很少有研究评估这些患者的结果。本研究旨在确定肠套叠诊断和治疗性灌肠之间的住院时间较短是否与复位成功率相关。
本研究旨在确定记录的肠套叠诊断和治疗性灌肠之间的时间延迟的患者中灌肠成功率和发病率。
对 2007 年至 2019 年间在一家儿童医院接受肠套叠治疗的儿科患者进行了回顾性评估。对患者的记录进行了回顾，以了解症状发作、放射学诊断和尝试灌肠的时间。对超声和射线照片进行了检查，以评估肠梗阻、游离腹腔液、套叠周围被困液体和肠壁灌注缺失。评估了复位尝试的效果、手术复位的需要以及包括肠切除和肠穿孔在内的并发症。
有 175 例回肠-结肠型肠套叠需要灌肠复位。在诊断后 1 小时内进行的 13 例（13/18）中，72.2%成功复位；在 1 至 3 小时内进行的 78 例（78/105）中，74.3%成功复位；在 3 至 6 小时内进行的 30 例（30/41）中，73.2%成功复位；在大于 6 小时内进行的 9 例（9/11）中，81.2%成功复位。短时间内的肠切除需求与诊断和复位尝试之间的时间没有关系（p=0.07）。
在肠套叠的影像学诊断和复位尝试之间的时间增加的情况下，患者的肠套叠复位效果或并发症发生率没有差异，包括长达 8 小时的延迟间隔。
