Pediatric Intussusception and Interventional Radiology in a Developing Country: Experience and Challenges of Ultrasound Saline Reduction Complementary to Primary Surgery

Abstract

Nonoperative reduction is considered a safe and effective treatment procedure for pediatric intussusception. However, the procedures are yet to be adopted in some developing countries. This study evaluates our experience with ultrasound saline reduction of pediatric intussusception in southeast Nigeria. Retrospective analysis of 58 children managed for intussusception from June 2009 to May 2013 at the University of Nigeria teaching hospital, Enugu. The median age at presentation was 7 months (IQR = 5 to 9 months), and the average duration of symptoms before diagnosis was 3.9 days (range, 1 to 14 days). Thirteen (22.4%) had saline hydrostatic reduction initially (11 succeeded, 2 failed), and a total of 47 cases had operative treatment (including the 2 with failed saline reduction). Operative procedures were right hemicolectomy in 24 cases, manual reduction 18, ileal resection 3, and colonic resection 2. Eighteen (38.3%) cases developed postoperative complications, and there were 2 postoperative deaths from unremitting septicemia. Comparison of the cases that had saline reduction with cases that underwent operative treatment showed a difference in the average time to diagnosis, need for preintervention transfusion, onset of oral intake, and average duration of admission. Challenges in the saline reduction procedure were delayed presentation, insufficient facilities and trained personnel. Ultrasound saline reduction procedure for pediatric intussusception is feasible in our setting. Despite the delay in presentation in most of our cases, this procedure may still be applied initially to patients who do not have clinical or radiologic contraindications.