Document Detail


Radiographic signs predictive of success of hydrostatic reduction of intussusception.
MedLine Citation:
PMID:  19727774     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIM: Outcome of hydrostatic reduction of intussusception (HRI) was analyzed according to specific radiographic signs to improve success. METHODS: At our institution, a pediatric surgical team performs HRI using a standardized protocol. We reviewed 266 consecutive HRI performed from 1998 to 2008 according to patient demographics, symptomatology, parameters of inflammation (peak WBC, peak CRP), position of the tip of the intussuscepted bowel and an intussusception bowel ratio (IBR). RESULTS: Of the 266 cases, 250 (94%) were successful (group A) and 16 (6%) failed (group B). Average age was significantly higher in group A than in group B (14.9 +/- 12.4 vs. 8.33 +/- 3.93 months) (P < 0.01). Duration of symptoms was significantly shorter in group A than in group B (15.0 +/- 12.5 vs. 25.0 +/- 9.7 h) (P < 0.05). The position of the tip was ascending colon (Ac): A = 34 (14%), B = 1 (6%); right transverse colon (RTc): A = 112 (45%), B = 1 (6%); left transverse colon (LTc): A = 84 (34%), B = 12 (75%); descending colon (Dc): A = 15 (6%), B = 0 (%); and sigmoid colon (Sc): A = 5 (2%), B = 2 (13%). The tip was located in LTc, Dc and Sc significantly more often in group B (14/16, 88%) than group A (104/250, 42%) (P < 0.01). IBR for group B (1.68 +/- 0.47) was significantly larger than group A (1.13 +/- 0.28) (P < 0.01). Differences in parameters of inflammation were not significant. CONCLUSIONS: We found that the position of the tip and IBR are predictive of success of HRI. Having a dedicated team perform HRI using a standardized protocol with consideration of IBR and the position of the tip eliminates bias, fosters reliability and ensures reproducibility, while at the same time it allows patients with inappropriate data to be spared potentially dangerous attempted HRI.
Authors:
Toshiaki Takahashi; Tadaharu Okazaki; Hiroko Watayo; Yuki Ogasawara; Nana Nakazawa; Yoshifumi Kato; Geoffrey J Lane; Atsuyuki Yamataka
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Pediatric surgery international     Volume:  25     ISSN:  1437-9813     ISO Abbreviation:  Pediatr. Surg. Int.     Publication Date:  2009 Nov 
Date Detail:
Created Date:  2009-10-20     Completed Date:  2010-02-02     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8609169     Medline TA:  Pediatr Surg Int     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  977-80     Citation Subset:  IM    
Affiliation:
Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.
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MeSH Terms
Descriptor/Qualifier:
Colonic Diseases / radiography*,  surgery*
Digestive System Surgical Procedures / methods
Female
Humans
Infant
Intussusception / radiography*,  surgery*
Male
Predictive Value of Tests
Remission Induction

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