Pretreatment clinical, laboratory, and imaging predictors of the outcome of pneumatic reduction of pediatric idiopathic ileocolic intussusception

Background/Purpose: Air enema reduction is considered by many authors to be the first line of treatment of idiopathic pediatric ileocolic intussusception. The aim of this retrospective study was to evaluate the results of the pneumatic reduction in our hospitals as a treatment of idiopathic pediatric ileocolic intussusception and to identify the pretreatment factors associated with pneumatic reduction failure. Methods: This was a multicenter chart review and database retrospective study conducted in tertiary general hospitals in Taif, Saudi Arabia. The study was conducted by revising the medical records of all pediatric patients who were admitted to the hospitals with picture suggestive of intussusception from January 2007 to December 2017. A total of 235 children were proved to have idiopathic ileocolic intussusception and initially treated by air reduction (AR) under fluoroscopic guidance. The primary outcome was the results of pneumatic reduction, and the secondary outcome was to identify the pretreatment factors associated with pneumatic reduction failure. Results: A total of 235 patients with male-to-female ratio 3:1 were included in the study with a mean age of 18.6 ± 4.3 months. The AR was successful in 87.2% of cases, perforation occurred in 0.9%, and the recurrence within the first 48 h was 6.3%. The risk factors which were significantly correlated with failed reduction were duration of symptoms >48 h, rectal bleeding, hemoglobin level <11.9 gm, neutrophils >66.8% of total neutrophil count, ultrasound poor prognostic signs, and body weight <11.7 kg. Conclusion: AR is safe and effective as a first-line treatment for pediatric idiopathic intussusception. A delay in presentation, presence of rectal bleeding, a high segmental neutrophils, low hemoglobin level, and low body weight, or/and presence of ultrasound bad prognostic signs, might be associated with reduction failure. The presence of these predictors of failure does not contraindicate the pneumatic reduction; however, the procedure should be carefully performed to avoid irreducibility and the risk of bowel perforation.