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Implementing ultrasound-guided hydrostatic reduction of intussusception in a low-resource country in Sub-Saharan Africa: our initial experience in Ethiopia

Abstract

Background

Despite advances in non-invasive radiological techniques for the treatment of intussusception, management of the entity still remains exclusively surgical in many developing countries, including Ethiopia. Fluoroscopic units are rare or mostly dysfunctional. Ultrasound scanners are more commonly available. Ultrasound-guided hydrostatic reduction (USGHR) was recently introduced to the main referral hospital in Ethiopia, and subsequently has been adopted as the initial management option for intussusception.

Purpose

The aim of this study was to evaluate our experience with USGHR in Ethiopia and measure the impact on patient care.

Methods

A prospective study was conducted between July 2014 and August 2015 on all pediatric patients, with US-confirmed intussusception, at the Tikur Anbessa Specialized Teaching Hospital in Addis Ababa, Ethiopia. All patients, excluding those with signs of peritonitis, bowel ischemia, or symptoms lasting longer than 4 days, were selected to undergo USGHR.

Results

A total of 53 children were diagnosed with intussusception, confirmed via ultrasound. Following exclusion criteria, USGHR was attempted in 47 of the patients. Forty-one of the 47 patients (87.2%) had successful reduction, resulting in a 77% overall rate of successful non-operative management in all patients with intussusception.

Conclusion

The rate of operative reduction of intussusception decreased by 77% following the introduction of USGHR as the initial non-surgical intervention. Therefore, we believe USGHR should be fully implemented in our hospital, and recommend that this study serves as an example to other institutions in our country as well as in other developing countries facing similar challenges.

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Authors

Corresponding author

Correspondence to Jonathan Zember.

Ethics declarations

This was a cross-sectional prospective study, approved by the Institutional Review Board, performed over a 14-month period from July 2014 to August 2015. All parents or caretakers of the patients undergoing the procedure were informed about the procedure and requested to sign informed written consent in their local language.

Conflict of interest

The authors declare that they have no conflict of interest.

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Wakjira, E., Sisay, S., Zember, J. et al. Implementing ultrasound-guided hydrostatic reduction of intussusception in a low-resource country in Sub-Saharan Africa: our initial experience in Ethiopia. Emerg Radiol 25, 1–6 (2018). https://doi.org/10.1007/s10140-017-1546-y

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Keywords

  • Intussusception
  • Intestinal obstruction
  • Hydrostatic reduction
  • Surgery