Factors associated with ultrasound-guided water enema reduction for pediatric intussusception in resource-limited setting: potential predictive role of thrombocytosis and anemia

Raymond Zhun Ming Lim, Terance Lee, Justin Yau Zane Ng, Kia Fatt Quek, Nyazirah Abdul Wahab, Shahrul Lokman Amansah, V. Muthu Alhagi M. Vellusamy, Chin Fang Ngim

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    3 Citations (Scopus)


    Background/purpose: Although ultrasound-guided hydrostatic reduction (USGHR) is increasingly used in managing pediatric intussusception, there is limited literature concerning its use in Malaysia. We aim to examine the experience and factors associated with the effectiveness of USGHR using water. Methods: This is a single-center retrospective observational study in a Malaysian tertiary referral center. Children with intussusception admitted between year 2012 and 2016 were included and medical records reviewed. Factors associated with success or failure of USGHR were identified using multivariable logistic regression. Results: Of the 172 cases included, 151 cases (87.8%) underwent USGHR, of whom 129 cases were successfully reduced (success rate of 85.4%). One perforation (0.7%) was reported. Age more than 3 years old (aOR = 7.16; 95% CI = 1.07–47.94; p = 0.042), anemia (aOR = 10.12; 95% CI = 1.12–91.35; p = 0.039), thrombocytosis (aOR = 11.21; 95% CI = 2.06–64.33; p = 0.005) and ultrasound findings of free fluid (aOR = 9.39; 95% CI = 1.62–54.38; p = 0.012) and left-sided intussusception (aOR = 8.18;95% CI = 1.22–54.90, p = 0.031) were independently associated with USGHR irreducibility. Symptom duration, blood in stool, vomiting and other clinical presentations, however, showed no association. Conclusions: USGHR with water is effective in the non-operative management of pediatric intussusception. Prolonged symptom duration need not necessarily preclude USGHR. The findings of anemia and thrombocytosis as independent predictors of USGHR irreducibility deserve further study. Type of study: Treatment study Level of evidence: III

    Original languageEnglish
    Pages (from-to)2312-2317
    Number of pages6
    JournalJournal of Pediatric Surgery
    Issue number11
    Publication statusPublished - Nov 2018


    • Anemia
    • Children
    • Intussusception
    • Platelets
    • Reduction
    • Water enema

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