Skip to main content
SpringerLink
Log in

Ultrasound-guided pneumatic reduction of intussusception in children: 15-year experience in a tertiary children’s hospital

  • Original Article
  • Published:
Pediatric Radiology Aims and scope Submit manuscript

Abstract

Background

International practice regarding the method used to nonoperatively reduce pediatric intussusception is variable.

Objective

To provide an overview of ultrasound-guided pneumatic intussusception reduction and assess its safety and effectiveness.

Materials and methods

A single-center prospective study was conducted in a tertiary referral pediatric hospital during the 15-year period between January 2008 and February 2023. All patients with ileocolic intussusception underwent abdominal sonographic examination for diagnosis. An ultrasound-guided pneumatic reduction of intussusception was then attempted. Children who were hemodynamically unstable, with signs of peritonitis or bowel perforation and those with sonographically detected pathologic lead points were excluded.

Results

A total of 131 children (age range 2 months to 6 years) were enrolled in this study. Pneumatic intussusception reduction was successful in 128 patients (overall success rate 97.7%). In 117 patients, the intussusception was reduced on the first attempt and in the remaining on the second. In three cases, after three consecutive attempts, the intussusception was only partially reduced. As subsequently surgically proven, two of them were idiopathic and the third was secondary to an ileal polyp. No bowel perforation occurred during the reduction attempts. There was recurrence of intussusception in three patients within 24 h after initial reduction which were again reduced by the same method.

Conclusion

Ultrasound-guided pneumatic intussusception reduction is a well-tolerated, simple, safe and effective technique with a high success rate, no complications and no ionizing radiation exposure. It may be adopted as the first-line nonsurgical treatment of pediatric intussusception.

Graphical Abstract

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data availability

The data used to support the findings of this study are available from the corresponding author upon request.

References

  1. del-Pozo G, Albillos JC, Tejedor D, Calero R, Rasero M, de-la-Calle U, López-Pacheco U (1999) Intussusception in children: current concepts in diagnosis and enema reduction. Radiographics 19:299–319

    Article  CAS  PubMed  Google Scholar 

  2. Navarro O, Dugougeat F, Kornecki A, Shuckett B, Alton J, Daneman A (2000) The impact of imaging in the management of intussusception owing to pathologic lead points in children. A review of 43 cases. Pediatr Radiol 30:594–603

    Article  CAS  PubMed  Google Scholar 

  3. Beasley SW (2017) The “ins” and “outs” of intussusception: where best practice reduces the need for surgery. J Paediatr Child Health 53:1118–1122

    Article  PubMed  Google Scholar 

  4. Fiorito ES, Recalde Cuestas LA (1959) Diagnosis and treatment of acute intestinal intussusception with controlled insufflation of air. Pediatrics 24:241–244

    Article  CAS  PubMed  Google Scholar 

  5. Kaplan SL, Magill D, Felice MA, Edgar JC, Anupindi SA, Zhu X (2017) Intussusception reduction: effect of air vs. liquid enema on radiation dose. Pediatr Radiol 47:1471–1476

    Article  PubMed  Google Scholar 

  6. Sadigh G, Zou KH, Razavi SA, Khan R, Applegate KE (2015) Meta-analysis of air versus liquid enema for intussusception reduction in children. AJR Am J Roentgenol 205:W542-549

    Article  PubMed  Google Scholar 

  7. Beres AL, Baird R (2013) An institutional analysis and systematic review with meta-analysis of pneumatic versus hydrostatic reduction for pediatric intussusception. Surgery 154:328–334

    Article  PubMed  Google Scholar 

  8. Guo JZ, Ma XY, Zhou QH (1986) Results of air pressure enema reduction of intussusception: 6,396 cases in 13 years. J Pediatr Surg 21:1201–1203

    Article  CAS  PubMed  Google Scholar 

  9. Stringer DA, Ein SH (1990) Pneumatic reduction: advantages, risks and indications. Pediatr Radiol 20:475–477. https://doi.org/10.1007/BF02075214

    Article  CAS  PubMed  Google Scholar 

  10. Meyer JS, Dangman BC, Buonomo C, Berlin JA (1993) Air and liquid contrast agents in the management of intussusception: a controlled, randomized trial. Radiology 188:507–511

    Article  CAS  PubMed  Google Scholar 

  11. Persliden J, Schuwert P, Mortensson W (1996) Comparison of absorbed radiation doses in barium and air enema reduction of intussusception: a phantom study. Pediatr Radiol 26:329–332

    Article  CAS  PubMed  Google Scholar 

  12. Shiels WE 2nd, Maves CK, Hedlund GL, Kirks DR (1991) Air enema for diagnosis and reduction of intussusception: clinical experience and pressure correlates. Radiology 181:169–172

    Article  PubMed  Google Scholar 

  13. Carroll AG, Kavanagh RG, Ni Leidhin C, Cullinan NM, Lavelle LP, Malone DE (2017) Comparative effectiveness of imaging modalities for the diagnosis and treatment of intussusception: a critically appraised topic. Acad Radiol 24:521–529

    Article  PubMed  Google Scholar 

  14. Burke LF, Clarke E (1977) Ileo-colic intussusception, a case report. J Clin Ultrasound 5:346–347. https://doi.org/10.1002/jcu.1870050514

    Article  CAS  PubMed  Google Scholar 

  15. Weissberg DL, Scheible W, Leopold GR (1977) Ultrasonographic appearance of adult intussusception. Radiology 124:791–792

    Article  CAS  PubMed  Google Scholar 

  16. Mirilas P, Koumanidou C, Vakaki M, Skandalakis P, Antypas S, Kakavakis K (2001) Sonographic features indicative of hydrostatic reducibility of intestinal intussusception in infancy and early childhood. Eur Radiol 11:2576–2580

    Article  CAS  PubMed  Google Scholar 

  17. Koumanidou C, Vakaki M, Pitsoulakis G, Kakavakis K, Mirilas P (2002) Sonographic detection of lymph nodes in the intussusception of infants and young children: clinical evaluation and hydrostatic reduction. AJR Am J Roentgenol 178:445–450

    Article  CAS  PubMed  Google Scholar 

  18. Applegate KE (2009) Intussusception in children: evidence-based diagnosis and treatment. Pediatr Radiol 39:S140–S143

    Article  PubMed  Google Scholar 

  19. Gondek AS, Riaza L, Cuadras D, Castellarnau XT, Krauel L (2018) Ileocolic intussusception: predicting the probability of success of ultrasound guided saline enema from clinical and sonographic data. J Pediatr Surg 53:599–604

    Article  PubMed  Google Scholar 

  20. Flaum V, Schneider A, Gomes Ferreira C, Philippe P, Sebastia Sancho C, Lacreuse I, Moog R, Kauffmann I, Koob M, Christmann D, Douzal V, Lefebvre F, Becmeur F (2016) Twenty years’ experience for reduction of ileocolic intussusception by saline enema under sonography control. J Pediatr Surg 51:179–182

    Article  PubMed  Google Scholar 

  21. Karadağ ÇA, Abbasoğlu L, Sever N, Kalyoncu MK, Yıldız A, Akın M, Candan M, Dokucu Aİ (2015) Ultrasound-guided hydrostatic reduction of intussusception with saline: safe and effective. J Pediatr Surg 5:1563–1565

    Article  Google Scholar 

  22. Plut D, Phillips GS, Johnston PR, Lee EY (2020) Practical imaging strategies for intussusception in children. AJR Am J Roentgenol 215:1449–1463

    Article  PubMed  Google Scholar 

  23. Todani T, Sato Y, Watanabe Y, Toki A, Uemura S, Urushihara N (1990) Air reduction for Intussusception in infancy and childhood: ultrasonographic diagnosis and management without X-ray exposure. Z Kinderchir 45:222–226

    CAS  PubMed  Google Scholar 

  24. Wang G, Liu XG, Zitsman JL (1995) Nonfluoroscopic reduction of intussusception by air enema. World J Surg 19:435–438

    Article  CAS  PubMed  Google Scholar 

  25. Gu L, Zhu H, Wang S, Han Y, Wu X, Miao H (2000) Sonographic guidance of air enema for intussusception reduction in children. Pediatr Radiol 30:339–342

    Article  CAS  PubMed  Google Scholar 

  26. Yoon CH, Kim HJ, Goo HW (2001) Intussusception in children: US-guided pneumatic reduction-initial experience. Radiology 218:85–88

    Article  CAS  PubMed  Google Scholar 

  27. Lee JH, Choi SH, Jeong YK, Kwon WJ, Jeong AK, Kang BS, Shin SH (2006) Intermittent sonographic guidance in air enemas for reduction of childhood intussusception. J Ultrasound Med 25:1125–1130

    Article  PubMed  Google Scholar 

  28. Joda AE, Salih WM, Shakarly NH (2017) Ultrasound guided pneumatic reduction of intussusception: a clinical experience from Baghdad. Am J Pediatr 3:76–82

    Article  Google Scholar 

  29. Chukwu IS, Ekenze SO, Ezomike UO, Chukwubuike KE, Ekpemo SC (2023) Ultrasound-guided reduction of intussusception in infants in a developing world: saline hydrostatic or pneumatic technique? Eur J Pediatr 182:1049–1056

    Article  PubMed  Google Scholar 

  30. Dung ED, Shitta AH, Alayande BT, Patrick TM, Kagoro B, Odunze N, Rikin C, Chirdan LB (2018) Pneumatic reduction of intussusception in children: experience and analysis of outcome at JUTH, Jos, a tertiary health centre in north central Nigeria. J West Afr Coll Surg 8:45–66

    CAS  PubMed  PubMed Central  Google Scholar 

  31. Samad L, Marven S, El Bashir H, Sutcliffe AG, Cameron JC, Lynn R, Taylor B (2012) Prospective surveillance study of the management of intussusception in UK and Irish infants. Br J Surg 99:411–415

    Article  CAS  PubMed  Google Scholar 

  32. Savoie KB, Thomas F, Nouer SS, Langham MR Jr, Huang EY (2017) Age at presentation and management of pediatric intussusception: a pediatric health information system database study. Surgery 161:995–1003

    Article  PubMed  Google Scholar 

  33. Bekdash B, Marven SS, Sprigg A (2013) Reduction of intussusception: defining a better index of successful non-operative treatment. Pediatr Radiol 43:649–656

    Article  PubMed  Google Scholar 

  34. Daneman A, Navarro O (2004) Intussusception. Part 2: an update on the evolution of management. Pediatr Radiol 34:97–187

    Article  PubMed  Google Scholar 

  35. Kirks DR (1995) Air intussusception reduction: “the winds of change.” Pediatr Radiol 25:89–91

    Article  CAS  PubMed  Google Scholar 

  36. Edwards EA, Pigg N, Courtier J, Zapala MA, MacKenzie JD, Phelps AS (2017) Intussusception: past, present and future. Pediatr Radiol 47:1101–1108

    Article  PubMed  Google Scholar 

  37. Fallon SC, Kim ES, Naik-Mathuria BJ, Nuchtern JG, Cassady CI, Rodriguez JR (2013) Needle decompression to avoid tension pneumoperitoneum and hemodynamic compromise after pneumatic reduction of pediatric intussusception. Pediatr Radiol 43:662–667

    Article  PubMed  Google Scholar 

  38. Stein-Wexler R, O’Connor R, Daldrup-Link H, Wootton-Gorges SL (2015) Current methods for reducing intussusception: survey results. Pediatr Radiol 45:667–674

    Article  PubMed  Google Scholar 

  39. Schmit P, Rohrschneider WK, Christmann D (1999) Intestinal intussusception survey about diagnostic and nonsurgical therapeutic procedures. Pediatr Radiol 29:752–761

    Article  CAS  PubMed  Google Scholar 

  40. Chew R, Ditchfield M, Paul E, Goergen SK (2017) Comparison of safety and efficacy of image-guided enema reduction techniques for paediatric intussusception: a review of the literature. J Med Imaging Radiat Oncol 61:711–717

    Article  PubMed  Google Scholar 

  41. Al-Meflh W, Abuquraa A, Khaswneh G (2016) Pneumatic reduction of pediatric intussusception: experience at Queen Rania Al-Abdullah Hospital for Children. J R Med Serv 23:13–19

    Google Scholar 

  42. Sanchez TR, Doskocil B, Stein-Wexler R (2015) Nonsurgical management of childhood intussusception: retrospective comparison between sonographic and fluoroscopic guidance. J Ultrasound Med 34:59–63

    Article  PubMed  Google Scholar 

  43. Singh AP, Tanger R, Mathur V, Mathur V, Gupta AK (2017) Pneumatic reduction of intussusception in children. Saudi Surg J 5:21–25 (https://www.saudisurgj.org/text.asp?2017/5/1/21/204419)

    Article  CAS  Google Scholar 

  44. Sandler AD, Ein SH, Connolly B, Daneman A, Filler RM (1999) Unsuccessful air-enema reduction of intussusception: is a second attempt worthwhile? Pediatr Surg Int 15:214–216

    Article  CAS  PubMed  Google Scholar 

  45. Naiditch JA, Rigsby C, Chin A (2012) Delayed repeated enema and operative findings after unsuccessful primary enema for intussusception. Eur J Pediatr Surg 22:404–408

    Article  PubMed  Google Scholar 

  46. Pazo A, Hill J, Losek JD (2010) Delayed repeat enema in the management of intussusception. Pediatr Emerg Care 26:640–645

    Article  PubMed  Google Scholar 

  47. Radu S, Lin S, Le LD, Fialkowski E, Zigman A (2022) Delayed repeat contrast enema for treatment of pediatric intussusception. J Surg Res 275:109–114

    Article  PubMed  Google Scholar 

  48. Gorenstein A, Raucher A, Serour F, Witzling M, Katz R (1998) Intussusception in children: reduction with repeated, delayed air enema. Radiology 206:721–724

    Article  CAS  PubMed  Google Scholar 

  49. Navarro OM, Daneman A, Chae A (2004) Intussusception: the use of delayed, repeated reduction attempts and the management of intussusceptions due to pathologic lead points in pediatric patients. AJR Am J Roentgenol 182:1169–1176

    Article  PubMed  Google Scholar 

  50. Lautz TB, Thurm CW, Rothstein DH (2015) Delayed repeat enemas are safe and cost-effective in the management of pediatric intussusception. J Pediatr Surg 50:423–427

    Article  PubMed  Google Scholar 

  51. Simanovsky N, Issachar O, Koplewitz B, Koplewitz B, Lev-Cohain N, Rekhtman D, Hiller N (2019) Early recurrence of ileocolic intussusception after successful air enema reduction: incidence and predisposing factors. Emerg Radiol 26:1–4

    Article  PubMed  Google Scholar 

  52. Caro-Domínguez P, Hernández-Herrera C, Le Cacheux-Morales C, Sánchez-Tatay V, Merchante-García E, Vizcaíno R, Fernández-Pineda I (2021) Ileocolic intussusception: ultrasound-guided hydrostatic reduction with sedation and analgesia. Radiologia 63:406–414

    Article  PubMed  Google Scholar 

  53. Giacalone M, Pierantoni L, Selvi V, Morabito A, Baldazzi M, Lima M, Lanari M, Masi S, Incerti F, Fierro F, Basile M, Lo Piccolo R, Catania VD, Bettini I, Parri N (2022) Midazolam premedication in ileocolic intussusception: a retrospective multicenter study. Eur J Pediatr 18:3531–3536

    Article  Google Scholar 

  54. Gal M, Gamsu S, Jacob R, Cohen DM, Shavit I (2022) Reduction of ileocolic intussusception under sedation or anaesthesia: a systematic review of complications. Arch Dis Child 107:335–340

    Article  PubMed  Google Scholar 

  55. Al-Tokhais T, Hsieh H, Pemberton J, Elnahas A, Puligandla P, Flageole H (2012) Antibiotics administration before enema reduction of intussusception: is it necessary? J Pediatr Surg 47:928–930

    Article  PubMed  Google Scholar 

  56. Zhang Y, Zou W, Zhang Y, Ye W, Chen X, Liu Q, Liu H, Si C, Jia H (2015) Reducing antibiotic use for young children with intussusception following successful air enema reduction. PLoS ONE 10:e0142999

    Article  PubMed  PubMed Central  Google Scholar 

  57. Golriz F, Cassady CI, Bales B, Herrejon C, Hicks MJ, Zhang W, Orth RC, Guillerman RP (2018) Comparative safety and efficacy of balloon use in air enema reduction for pediatric intussusception. Pediatr Radiol 48:1423–1431

    Article  PubMed  Google Scholar 

  58. Shiels WE 2nd (2013) Childhood intussusception: the safety case. Pediatr Radiol 43:659–661

    Article  PubMed  Google Scholar 

  59. Daneman A, Alton DJ, Ein S, Wesson D, Superina R, Thorner P (1995) Perforation during attempted intussusception reduction in children–a comparison of perforation with barium and air. Pediatr Radiol 25:81–88

    Article  CAS  PubMed  Google Scholar 

  60. Lee DH, Lim JH, Ko YT, Yoon Y (1990) Sonographic detection of pneumoperitoneum in patients with acute abdomen. AJR Am J Roentgenol 154:107–109

    Article  CAS  PubMed  Google Scholar 

  61. Zhou AZ, Toporowski A, Tsung JW (2019) Sonographic evaluation and monitoring of pneumoperitoneum after air enema reduction for intussusception. Pediatr Emerg Care 35:e133–e134

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Radiology Department, Children’s Hospital P. & A. Kyriakou, Thivon & Livadias, Ampelokipi, 11527, Athens, Greece

    Marina Vakaki, Rodanthi Sfakiotaki, Sergia Liasi, Anna Hountala, Eleni Koutrouveli, Irene Vraka, Christina Zouridaki & Chrysoula Koumanidou

Authors
  1. Marina Vakaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rodanthi Sfakiotaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sergia Liasi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Anna Hountala
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Eleni Koutrouveli
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Irene Vraka
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Christina Zouridaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Chrysoula Koumanidou
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

M.V. conceived the study and was in charge of overall direction and planning. M.V. and R.S. performed data collection. M.V. wrote the manuscript (with support from R.S.). M.V., R.S., and S.L. contributed to the final version of the manuscript. S.L. worked out the technical details, interpreted the images and performed the statistical analysis. M.V. and R.S. performed reviews and revisions. All authors discussed the results and contributed to the final manuscript. All authors provided critical feedback and helped shape the research, analysis and manuscript. All authors approved the final version of the manuscript.

Corresponding author

Correspondence to Marina Vakaki.

Ethics declarations

Ethics approval

Approval was obtained from the Institutional Review Board and Ethical Committee of P. & Α. Κyriakou Children’s Hospital. (The procedures used in this study adhere to the tenets of the Declaration of Helsinki.)

Conflicts of interest

None

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 Cine ultrasound images of a 2-year-old girl who presented with intermittent abdominal pain and vomiting for 24 hours (same patient as in Fig. 2). The video demonstrates the final stage of the reduction procedure. The air column has already approached the intussusception and air bubbles are seen between the intussusceptum and the intussuscipiens. Subsequently, the air pushing the head of the intussusception, which initially resists, at the end rushes into the ileum filling the screen; the intussusception has just been reduce. (MP4 39300 KB)

Supplementary file2 Cine ultrasound images of a 2-year-old girl who presented with intermittent abdominal pain and vomiting for 24 hours (same patient as in Fig. 2). The video, which is the sequel to Supplementary Material 1, demonstrates the stepwise appearance of the edematous terminal ileum after the completion of the reduction procedure. The graded compression technique holds the key to achieving that, confirming the reduction of the intussusception. (MP4 39498 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vakaki, M., Sfakiotaki, R., Liasi, S. et al. Ultrasound-guided pneumatic reduction of intussusception in children: 15-year experience in a tertiary children’s hospital. Pediatr Radiol 53, 2436–2445 (2023). https://doi.org/10.1007/s00247-023-05730-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00247-023-05730-6

Keywords

Search

Navigation