Efficacy of Ultrasound Guided Hydrostatic Reduction of Intussusceptions in Children
Journal Title: New Indian Journal of Surgery - Year 2019, Vol 10, Issue 3
Abstract
Aim: To study the efficacy of hydrostatic reduction of childhood intussusception using normal saline under US guidance. Materials and Methods: This prospective study was conducted over a period of 3 years from February 2016 to January 2019. All Children between three months to five years whose ultrasound scan shows Intussusception, symptoms of intussusception less than 48 hours and no features of peritonitis or intraperitoneal free gas were included in the study. Informed written consent was taken from the patient’s guardian for hydrostatic reduction. The child was sedated with midazolam and ketamine. A Foley’s catheter of size 14 Fr to 18 Fr were used according to the age of the child. Catheter was lubricated with 2% lignocaine gel and introduced into the rectum. The balloon of Foley’s catheter inflated with 10-15 ml distilled water, Catheter was connected with warm normal saline bag and flow of saline was allowed into the rectum. The saline bag was suspended on a drip stand at approximately 100 cm from the patient’s bed level. The ultrasound was then used to guide the reduction till the intussusception went beyond the ileocaecal valve. Complete reduction was assumed once intussusceptum was disappeared and passage of saline through the ileo-caecal valve into the ileum seen. Results: This study was done on total 35 patients diagnosed with intussusceptions, 21 males (60%) and 14 females (40%), the age ranged between 3 month and 5 years. Abdominal USG and plain X-ray were done for all patients. Abdominal pain was seen in 32 patients (91.4%), bilious vomiting in 30 patients (85.7%), rectal bleeding in 12 patients (34.3%), abdominal distension in 18 patients (51.4%), palpable abdominal mass was seen in 14 patients (40%) and absent bowel sound was seen in 12 (34.3%) patients. Volume of Normal saline required for reduction ranged from 300ml to 1300ml. Three of the children had recurrent intussusceptions. Two occurred a day after the procedure and one recurrence was noted four months later. In three patients (8.6%), US Guided hydroreduction of intussusception failed and they underwent surgical exploration. Conclusion: Ultrasound guided reduction of intussusception with saline is safe and effective method with high success rates with minimal morbidity or mortality due to the procedure.
Authors and Affiliations
Ravindra Devani
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- EP ID EP594958
- DOI 10.21088/nijs.0976.4747.10319.19
- Views 90
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