Comparing sedative and non-sedative reduction techniques in paediatric intussusception: Insights from a 6-year study.

Q3 Medicine

Medical Journal of Malaysia Pub Date : 2024-08-01

E Purnomo, K Gibran, A Makhmudi, D Andi, Gunadi

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引用次数: 0

Abstract

Introduction: Intussusception is a prevalent paediatric emergency condition. The standard of care involves the reduction using air or fluid enema is considered a safe procedure. Sedation-induced muscle relaxation thus optimising the treatment. We present a comprehensive 6- year study involving non sedative reduction (NSR) versus sedative reduction (SR) utilising ketamine and midazolam.

Materials and methods: A retrospective cohort study was conducted between January 2017 and July 2023 in Yogyakarta, Indonesia. A total of 85 children diagnosed with intussusception underwent hydrostatic reduction, which employed water-soluble contrast administered into the rectum. Cases that were unsuccessful in reduction underwent immediate surgical intervention.

Results: Among the 85 children with intussusception underwent reduction, 22 children underwent the SR procedure and 63 underwent NSR procedure. We found a successful outcome in 17 cases (77%) of SR procedure with one recurrent and the other five (23%) got surgical reduction such as anastomosis resection (3 cases) due to Meckel- Diverticula. On the other hand, we found 24 successful cases (38.0%) in NSR procedure with one recurrent after case. 39 others who failed with NSR continued to surgical reduction. Manual reduction was done for 31 patients with one case mortality due to pulmonary bleeding. Anastomosis resection (4 cases) and, stoma (4 cases) were decided for others surgical reduction. The relative risk (RR) on this study was 2.02 (p value < 0.05, CI 95%).

Conclusion: Implementation of the SR procedure may reduce surgery rates in paediatric intussusception, thereby enhancing patient management. Furthermore, the success rate of hydrostatic reduction higher in under sedation procedure. We contribute to evolve insight of non-operative approaches of paediatric intussusception management, particularly in the Yogyakarta.

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比较小儿肠套叠的镇静和非镇静减压技术：6 年研究的启示

导言肠套叠是一种常见的儿科急症。标准的治疗方法是使用空气或液体灌肠，这种方法被认为是安全的。镇静可诱导肌肉放松，从而优化治疗效果。我们介绍了一项为期 6 年的综合研究，涉及使用氯胺酮和咪达唑仑的非镇静减容术（NSR）与镇静减容术（SR）：我们于 2017 年 1 月至 2023 年 7 月在印度尼西亚日惹开展了一项回顾性队列研究。共有 85 名确诊为肠套迭的儿童接受了静水压减压术，即在直肠内注射水溶性造影剂。缩肛不成功的病例则立即接受手术治疗：在接受缩肛手术的 85 名肠套叠患儿中，22 名患儿接受了 SR 手术，63 名患儿接受了 NSR 手术。我们发现，17 例（77%）成功实施了 SR 手术，其中 1 例复发，另外 5 例（23%）因梅克尔憩室（Meckel- Diverticula）而实施了手术缩窄，如吻合器切除术（3 例）。另一方面，我们发现有 24 例（38.0%）成功实施了 NSR 手术，其中一例复发。另外 39 例 NSR 失败的患者继续进行了手术切除。31例患者进行了人工切除，其中一例因肺出血而死亡。其他手术切除患者则选择了吻合口切除术（4 例）和造口术（4 例）。本研究的相对风险（RR）为 2.02（P 值小于 0.05，CI 95%）：结论：SR 程序的实施可降低小儿肠套叠的手术率，从而加强对患者的管理。此外，静水减容术在镇静状态下的成功率更高。我们对小儿肠套叠的非手术治疗方法，尤其是日惹地区的非手术治疗方法的发展做出了贡献。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Medical Journal of Malaysia Medicine-Medicine (all)

CiteScore

1.20

自引率

0.00%

发文量

165

期刊介绍： Published since 1890 this journal originated as the Journal of the Straits Medical Association. With the formation of the Malaysian Medical Association (MMA), the Journal became the official organ, supervised by an editorial board. Some of the early Hon. Editors were Mr. H.M. McGladdery (1960 - 1964), Dr. A.A. Sandosham (1965 - 1977), Prof. Paul C.Y. Chen (1977 - 1987). It is a scientific journal, published quarterly and can be found in medical libraries in many parts of the world. The Journal also enjoys the status of being listed in the Index Medicus, the internationally accepted reference index of medical journals. The editorial columns often reflect the Association''s views and attitudes towards medical problems in the country. The MJM aims to be a peer reviewed scientific journal of the highest quality. We want to ensure that whatever data is published is true and any opinion expressed important to medical science. We believe being Malaysian is our unique niche; our priority will be for scientific knowledge about diseases found in Malaysia and for the practice of medicine in Malaysia. The MJM will archive knowledge about the changing pattern of human diseases and our endeavours to overcome them. It will also document how medicine develops as a profession in the nation. We will communicate and co-operate with other scientific journals in Malaysia. We seek articles that are of educational value to doctors. We will consider all unsolicited articles submitted to the journal and will commission distinguished Malaysians to write relevant review articles. We want to help doctors make better decisions and be good at judging the value of scientific data. We want to help doctors write better, to be articulate and precise.