Sedated ultrasound guided saline reduction (SUR) of ileocolic intussusception: 20 year experience

• Published in: Journal of pediatric surgery Vol. 55; no. 10; pp. 2009 - 2014
• Main Authors: Sacks, Robert S., Anconina, Reut, Farkas, Evelyn, Zolotnik-Krupenich, Diana, Kravarusic, Dragan, Tsodikov, Vadim, Shelef, Ilan, Taragin, Benjamin
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-10-2020
• Subjects: Child; Enema - methods; Humans; Hypnotics and Sedatives - therapeutic use; Intussusception; Intussusception - diagnostic imaging; Intussusception - therapy; Propofol - therapeutic use; Retrospective Studies; Saline enema; Saline Solution - therapeutic use; Sedation; Ultrasonography, Interventional; Ultrasound guided; Saline enema; Ultrasound guided; Sedation; Intussusception
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2020.05.049

Ileocolic intussusception is a common abdominal emergency in children, diagnosed routinely with ultrasound and treated most frequently with fluoroscopic pneumatic reduction without sedation. Alternatively, ultrasound can also be used to obviate ionizing radiation and sedation can be used to avoid discomfort from the procedure. The purpose of this study was to present our experience with sedation using saline enema under ultrasound guided control to reduce ileocolic intussusception.
This is a retrospective study of patients with ileocolic intussusception presenting to a tertiary care hospital between 1998 and 2018. We excluded the data of patients that underwent either fluoroscopic guided reduction with barium enema or primary surgery. All patients received sedation with propofol and subsequently underwent our sedated ultrasound guided saline reduction (SUR) protocol until reduction was confirmed.
414 total reductions were performed in the 338 children who underwent our SUR protocol, of which 86.0% were successful. Zero perforations occurred during attempted reduction. 58 patients required surgery after a failed reduction (14.0%). There were 76 recurrent episodes that underwent our SUR protocol, of which 93.4% had a successful reduction.
The success rate of reduction was high and compared similarly to techniques that either use pneumatic reduction under radiation or refrain from administering a sedative prior to enema.
Treatment study level III.