Treatment outcome of ultrasound-guided hydrostatic reduction of intussusception and its associated factors among pediatric patients in a resource-limited setting

Abstract

<title>Abstract</title> <bold>Background:</bold> Ultrasound-guided hydrostatic reduction (USGHR) of intussusception was recently introduced and adopted as the initial management option for intussusception in children. Knowledge of the treatment outcome and associated factors will enhance the expansion of this technique to hospitals in Sub-Saharan Africa, where surgery largely remains the exclusive treatment strategy. <bold>Methods:</bold> An institution-based cross-sectional study was conducted. We consecutively enrolled children with US-confirmed intussusception for whom USGHR of intussusception with normal saline was performed by a senior radiologist and/or final-year residents after ruling out contraindications. Firth’s logistic regression analysis was undertaken to determine odds ratios (ORs) and 95% confidence intervals (CIs) of factors predictive of successful outcomes. <bold>Results: </bold>A total of 145 children with a mean age of 24 months were enrolled in the current study. The majority of patients 123 (84.8%) presented within 24 hours of symptom onset and colicky abdominal pain was the most common complaint 79 (54.5%). Ileocolic type and short-length intussusception were visualized more on ultrasound 135 (93.1) and 118 (81.4%), respectively. The overall reduction success rate was 93.1% [95% CI (89.0-97.2)]. Ten patients (13.5%) underwent surgery after a failed hydrostatic reduction with good postoperative outcomes. Reported duration of illness less than 24 hours Adjusted odds ratio (AOR) 6.77 (95% CI [1.25-30.42]) and length of intussusception less than 3.5 cm AOR 6.24 [95% CI (1.18-33.00)] were significantly associated with successful hydrostatic reduction outcomes. <bold>Conclusion:</bold> We have found a high success rate of USGHR of intussusception in an implementation phase and a relatively low resource setup. Early presentation and short intussusception segments were favorably associated with successful outcomes.