Factors for failed pneumatic reduction of intussusception in children
Abstract
Intussusception is the most common cause of intestinal obstruction in children under 2 years of age. The fluoroscopy-guided pneumatic reduction procedure is currently used as the first-line non-operative reduction method. Many factors associated with failed pneumatic reduction. Objectives of retrospective case control study was to find out factors associated with failed pneumatic reduction of intussusception in pediatric patients under 2 years of age, admitted to Udonthani hospital, Thailand, between January 2015 and December 2020. Data were collected from medical records for statistical analyses to find out those factors.
Result: One hundred and six cases (66 males and 40 females) of intussusception were treated with pneumatic reduction. Successful reduction was achieved in 70 cases during the study period (66.04%). The median age at presentation was 9 months old (range 3 – 23). Only 2 cases were complicated by perforation (1.89%) and 1 case by early recurrence (1.43%). Failed pneumatic reduction group had significant higher number of cases than successful pneumatic reduction group in many factors; age ≤7 months (47.22% vs. 24.29%, p=0.017), duration of symptom > 2 days (36.11% vs. 15.71%, p=0.017), body temperature ≥ 37.8oC (52.78% vs. 27.14%, p=0.009), rectal bleeding (97.22% vs. 60.00%, p<0.001), location of intussusception at splenic flexor and distal to splenic flexor (47.22% vs. 21.43%, p=0.006) and radiological findings of complete intestinal obstruction (91.67% vs. 62.86%, p=0.002)
From Multivariate analysis, independent predictor failure of pneumatic reduction with statistically significant were duration of symptom > 2 days, rectal bleeding and radiological findings of complete intestinal obstruction with adjusted odd ratio 0.24 (95%CI 0.07-0.85, p = 0.028), 0.07 (95%CI 0.01-0.67, p = 0.021) and 0.22 (95%CI 0.05-0.94, p = 0.041) respectively.
Conclusion: This study found that age duration of symptom > 2 days, rectal bleeding and radiological findings of complete intestinal obstruction were factors for failed pneumatic reduction of intussusception.
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