Abstract
Purpose
This study was undertaken to compare the effectiveness of ultrasound-guided Hartmann’s solution enema (US-E) and radiological liquid enema (RX-E) in reducing idiopathic ileocecocolic intussusceptions in relation to patient age and symptom duration.
Materials and methods
The study group consisted of 42 patients with idiopathic ileocecocolic intussusception treated with US-E (20 patients) or RX-E (23 patients), with one patient undergoing both procedures owing to recurrence. Patients were divided into subgroups according to age (<6 months, 6–12 months, >12 months) and symptom duration (<12 h, 12–24 h, >24 h).
Results
Complete reduction was achieved in 15/20 patients treated with US-E (75%) and in 10/23 treated with RX-E (43.5%) (p=ns). Recurrence was observed in 1/20 US-E and 0/23 RX-E (p=ns) patients. No complications were encountered. US-E had a significantly higher success rate than RX-E in patients >12 months (p=0.0063) and with symptom duration >24 h (p=0.0361). No differences were found in the other subgroups (p=ns).
Conclusions
US-E and RX-E are procedures of comparable value and safety in reducing idiopathic intussusception. US-E seems to be more effective in patients >12 months or with symptom duration >24 h. As US-E avoids radiation exposure, it should be considered the first-choice procedure for reducing idiopathic ileocecocolic intussusception, particularly in these two subgroups of patients.
Riassunto
Obiettivo
Scopo del presente lavoro è stato confrontare l’efficacia del clisma eco-guidato con soluzione di Hartmann (US-E) e del clisma radiologico liquido (RX-E) nella riduzione dell’invaginazione idiopatica ileo-cecocolica, in rapporto all’età e al tempo d’insorgenza della sintomatologia.
Materiali e metodi
Sono stati inclusi nello studio 42 pazienti ricoverati consecutivamente per invaginazione idiopatica ileo-ceco-colica e sottoposti a US-E (20 casi) o a RX-E (23 casi), con 1 paziente trattato con entrambe le procedure per recidiva dell’invaginazione. La popolazione è stata divisa in sottogruppi per età (<6 mesi, 6–12 mesi, >12 mesi) e per durata della sintomatologia (<12 ore, 12–24 ore, >24 ore).
Risultati
La riduzione completa dell’invaginazione è stata ottenuta in 15/20 US-E (75%) e in 10/23 RX-E (43,5%) (p=ns). L’invaginazione è recidivata in 1/20 US-E e 0/23 RX-E (p=ns). Non sono state osservate complicanze. Il US-E è risultato più efficace del RX-E nei pazienti di età maggiore di 12 mesi (p=0,0063) e nei casi in cui c’è stato esordio della sintomatologia da meno di 24 ore (p=0,0361).
Conclusioni
Il US-E e il RX-E sono procedure di efficacia e sicurezza sovrapponibili nella riduzione dell’invaginazione intestinale idiopatica. Il US-E risulta più efficace nei pazienti di età superiore ai 12 mesi e nei casi in cui c’è stato esordio della sintomatologia da più di 24 ore. Poiché il US-E non comporta esposizione radiologica, è da considerarsi metodica di prima scelta per la riduzione dell’invaginazione idiopatica ileo-ceco-colica, in particolare in questi due sottogruppi di pazienti.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References/Bibliografia
Ko HS, Schenk JP, Troger J et al (2007) Current radiological management of intussusception in children. Eur Radiol 17:2411–2421
Navarro O, Dugougeat F, Kornecki A et al (2000) The impact of imaging in the management of intussusception owing to pathologic lead points in children. Pediatr Radiol 30:594–603
Blakelock RT, Beasley SW (1998) The clinical implications of non-idiopathic intussusception. Pediatr Surg Int 14:163–167
Retan GM (1927) Nonoperative treatment of intussusception. Am J Dis Child 33:765–770
Del-Pozo G, Albillos JC, Tejedor D et al (1999) Intussusception in children: current concepts and enema reduction. Radiographics 19:299–319
Justice FA, De Campo M, Liem NT et al (2007) Accuracy of ultrasonography for the diagnosis of intussusception in infants in Vietnam. Pediatr Radiol 37:195–199
Bai YZ, Qu RB, Wang GD et al (2006) Ultrasound-guided reduction of intussusception by saline enema: a review of 5218 cases in 17 years. Am J Surg 192:273–275
Crystal P, Hertzanu Y, Farber B et al (2002) Sonographically guided hydrostatic reduction of intussusceptions in children. J Clin Ultrasound 30:343–348
Peh WCG, Khong PL, Chan KL et al (1996) Sonographically guided hydrostatic reduction of childhood intussusception using Hartmann’s solution. AJR Am J Roentgenol 167:1237–1241
Daneman A, Navarro O (2004) Intussusception. Part 2: an update on the evolution of management. Pediatr Radiol 34:97–108
Chan KL, Saing H, Peh WC et al (1997) Childhood intussusception: ultrasound-guided Hartmann’s solution hydrostatic reduction or barium enema reduction? J Pediatr Surg 32:3–6
Simanovsky N, Hiller N, Koplewitz BZ et al (2007) Is non-operative intussusception reduction effective in older children? Ten-year experience in a university affiliated medical center. Pediatr Surg Int 23:261–264
Katz M, Phelan E, Carlin JB et al (1993) Gas enema for the reduction of intussusception: relationship between clinical signs and symptoms and outcome. AJR Am J Roentgenol 160:363–366
Beasley SW, Glover J (1992) Intussusception: prediction of outcome of gas enema. J Pediatr Surg 27:474–475
Okazaki T, Ogasawara Y, Nakazawa N et al (2006) Reduction of intussusception in infants by a pediatric surgical team: improvement in safety and outcome. Pediatr Surg Int 22:897–900
Shapkina AN, Shapkin VV, Nelubov IV et al (2006) Intussusception in children: 11-year experience in Vladivostok. Ped Surg Int 22:901–904
Okuyama H, Nakai H, Okada A (1999) Is barium enema reduction safe and effective in patients with a long duration of intussusceptions? Pediatr Surg Int 15:105–107
Shehata S, El Kholi N, Sultan A et al (2000) Hydrostatic reduction of intussusception: barium, air or saline? Pediatr Surg Int 16:380–382
Barr LL, Stansberry SD, Swischuk LE (1990) Significance of age, duration, obstruction and the dissection sign in intussusceptions. Pediatr Radiol 20:454–456
Swischuk LE (1992) The current radiologic management of intussusceptions: a survey and review. Pediatr Radiol 22:317
Meyer JS, Dangman BC, Buonomo C et al (1993) Air and liquid contrast agents in the management of intussusception: a controlled, randomized trial. Radiology 188:507–511
Ginai AZ (1985) Experimentation evaluation of various available contrast agents for use in the gastrointestinal tract in case of suspected leakage: effects on peritoneum. Br J Radiol 58:969–978
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Di Renzo, D., Colangelo, M., Lauriti, G. et al. Ultrasound-guided Hartmann’s solution enema: first-choice procedure for reducing idiopathic intussusception. Radiol med 117, 679–689 (2012). https://doi.org/10.1007/s11547-011-0769-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11547-011-0769-3
Keywords
- Intussusception
- Ultrasonography
- Hydrostatic reduction
- Hartmann’s solution enema
- Gastrografin enema
- Paediatric