Treatment outcome of ultrasound-guided hydrostatic reduction of intussusception and its associated factors among pediatric patients in a resource-limited setting.

Abstract

Background: Ultrasound (US)-guided hydrostatic reduction of intussusception was recently introduced and adopted as the first-line management for intussusception in children at Tibebe Ghion Specialized Hospital. Knowledge of the treatment outcome and associated factors will enhance the expansion of this technique to hospitals in Sub-Saharan Africa, where surgery largely remains the exclusive treatment strategy.

Methods: An institution-based cross-sectional study was conducted at Tibebe Ghion Specialized Hospital, Bahir Dar, Ethiopia. We consecutively enrolled children with US-confirmed intussusception for whom US-guided hydrostatic reduction with normal saline was performed by a general radiologist and/or final-year residents under supervision after ruling out contraindications. Firth's logistic regression analysis was undertaken to determine odds ratios (ORs) and 95% confidence intervals (CIs) of factors predictive of successful outcomes.

Results: A total of 145 children with a mean age of 24 months were enrolled in the current study. Most patients (123, 84.8%) presented within 24 h of symptom onset, with colicky abdominal pain being the main complaint (79, 54.5%). Ileocolic type and short-length intussusception were visualized more on US, 135 (93.1) and 118 (81.4%), respectively. The overall reduction rate was 93.1% (95% CI [89.0-97.2]). Ten patients (6.9%) underwent surgery after a failed hydrostatic reduction, with good postoperative outcomes. Reported duration of illness of less than 24 h, adjusted odds ratio (AOR) of 6.77 (95% CI [1.25-30.42]), and length of intussusception of less than 3 cm (AOR, 6.24; 95% CI [1.18-33.00]) were significantly associated with successful hydrostatic reduction outcomes.

Conclusion: We have found a high US-guided hydrostatic reduction rate of intussusception in an implementation phase and a relatively low resource setup. Early presentation and short intussusception segment were favorably associated with successful outcomes.