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Vol. 63. Issue 5.
Pages 406-414 (September - October 2021)
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Vol. 63. Issue 5.
Pages 406-414 (September - October 2021)
Original articles
Ileocolic intussusception: Ultrasound-guided hydrostatic reduction with sedation and analgesia
Invaginación ileocólica: reducción hidrostática ecoguiada con sedoanalgesia
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P. Caro-Domíngueza,
Corresponding author
pablocaro82@hotmail.com

Corresponding author.
, C. Hernández-Herreraa, C. Le Cacheux-Moralesa, V. Sánchez-Tatayb, E. Merchante-Garcíaa, R. Vizcaínoc, I. Fernández-Pinedac
a Unidad de Radiología Pediátrica, Departamento de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, Spain
b Servicio de Urgencias Pediátricas, Hospital Universitario Virgen del Rocío, Sevilla, Spain
c Departamento de Cirugía Pediátrica, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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Tables (2)
Table 1. Comparison of fluoroscopy-guided ileocolic intussusception reduction with barium to ultrasound-guided reduction with water.
Table 2. Comparison of factors that may influence successful ileocolic intussusception reduction with barium or water monitored with imaging techniques versus patients who required surgical intervention.
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Abstract
Introduction

The first-choice treatment for ileocolic intussusception is imaging-guided reduction with water, air, or barium. The objectives of the current study were to evaluate the efficacy and safety of ultrasound-guided reduction of intussusception using water in patients under sedation and analgesia. We compare this approach with our previous experience in reduction using barium under fluoroscopic guidance without sedation and analgesia and investigate what factors predispose to surgical correction.

Material and methods

We retrospectively reviewed cases of children with ileocolic intussusception treated in a third-level pediatric hospital during a 52-month period: during the first 24 months, reduction was done using barium and fluoroscopy without sedoanalgesia, and during the following 28 months, reduction was done using water and ultrasound with sedoanalgesia. A pediatric radiologist and a pediatrician reviewed the clinical history, surgical records, and imaging studies.

Results

In the 52-month period, 59 children (41 boys and 18 girls; mean age, 16.0 months) were diagnosed with ileocolic intussusception at our hospital. A total of 33 reductions (28 patients and 5 recurrences) were done using barium under fluoroscopic guidance, achieving a 61% success rate. A total of 38 reductions (31 patients and 7 recurrences) were done using water under ultrasound guidance with patients sedated, achieving a success rate of 76%. No significant adverse effects were observed in patients undergoing ultrasound-guided hydrostatic reduction under sedation, and the success rate in this group was higher (p = 0.20). The factors that predisposed to surgical reduction were greater length of the intussusception (p = 0.03), location in areas other than the right colon (p = 0.002), and a greater length of time between symptom onset and imaging tests (p = 0.08).

Conclusion

Ultrasound-guided hydrostatic reduction of ileocolic intussusception under sedoanalgesia is efficacious and safe.

Keywords:
Intussusception
Reduction
Analgesia
Sedation
Ultrasound
Resumen
Introducción

La primera opción de tratamiento de la invaginación ileocólica es la reducción con agua, aire o bario guiada por imagen. Los objetivos de este estudio fueron evaluar la eficacia y seguridad de la desinvaginación usando agua guiada por ecografía bajo sedoanalgesia. La comparamos con nuestra experiencia previa con bario y guiada por fluoroscopia sin sedación e investigamos qué factores predispusieron a la corrección quirúrgica.

Material y métodos

Revisión retrospectiva de niños con invaginación ileocólica tratados en un hospital pediátrico de tercer nivel en un periodo de 52 meses; los primeros 24 meses, los niños fueron sometidos a reducción fluoroscópica con bario sin sedación y los siguientes meses a reducción hidrostática ecoguiada con sedoanalgesia. Un radiólogo pediátrico y una pediatra revisaron la historia clínica, hojas quirúrgicas y estudios de imagen.

Resultados

59 niños (41 niños y 18 niñas; edad media, 16,0 meses) fueron diagnosticados de invaginación intestinal en nuestro hospital en un periodo de 52 meses. Se realizaron 33 reducciones (28 pacientes y 5 recurrencias) guiadas por fluoroscopia usando bario, con una tasa de éxito del 61%. Treinta y ocho desinvaginaciones (31 pacientes y 7 recurrencias) utilizando agua, guiadas por ecografía bajo sedación, tuvieron una tasa de éxito del 76%. La tasa de éxito fue superior en el segundo grupo en el que se usó sedación (p = 0,20), sin que se detectaran efectos secundarios significativos. Los factores que predispusieron a la reducción quirúrgica fueron las invaginaciones de mayor longitud (p = 0,03), las que no se localizaron en colon derecho (p = 0,002) y en las que hubo un mayor intervalo desde el inicio de los síntomas a la prueba de imagen (p = 0,08).

Conclusión

La reducción de la invaginación ileocólica guiada por ecografía usando agua y sedoanalgesia es una técnica eficaz y segura.

Palabras clave:
Invaginación
Reducción
Analgesia
Sedación
Ecografía

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