The effect of clinical and radiological findings on sonographic reduction success in invagination with saline

PURPOSE: Intussusception can be defined as the intersection of two consecutive intestinal segments of the gastrointestinal tract. Intussusception is the most common cause of intestinal obstruction in children 3-24 months age. Beside being the first choice in the diagnosis of intussusception, ultrasound-guided hydrostatic reduction technique is frequently used as a non-surgical treatment of intussusception. The aim of this study was to investigate the factors influencing success of hydrostatic reduction in patients with intussusception. In this study age, gender, clinical findings and the size of intussuscepted bowel segment, as well as presence of intraabdominal lymph node and fluid in prediction the success of hydrostatic reduction investigated. MATERİALS AND METODS: 104 patients were diagnosed with intussusception between 2012-2017 years were included in the study. We used ultrasound (Siemens Antares) 4-9 and 5-13 MHz convex and linear probes for diagnosis and ultrasound-guided hydrostatic reduction of intussusception. Hydrostatic reduction was performed in the patients diagnosed with intussusception. RESULTS: 82 patients (%78.8) were successfully treated with hydrostatic reduction, in 22 patients (%21.2) the reduction was unsuccessful and treated surgically. Sixty-five patients were male (%62.5) and 39 patients were female (%37.5) of the 104 patients. The most common clinical findings were abdominal pain (%80), vomiting (%62), bloody stool (%30), diarrhea (%13.5), constipation (%8). The effects of presence intraabdominal lymph node and fluid beside the length and diameter of intussusception on reduction success were investigated. Clinical findings such as abdominal pain, vomiting, bloody stool, diarrhea, and constipation has no statistically significant difference in patient with unsuccessful reduction (P<0,05). The hydrostatic reduction was unsuccessful in patients with increased length and diameter of intussusception (P<0,05). The patients with intraabdominal lymph node and fluid, the recurrence of intussusception and hydrostatic reduction procedure failure attempts statistically significant increased (P<0,05). The mean intestinal segment length was found to be 7.2 cm in patients who underwent unsuccessful hydrostatic reduction while 4.15 cm in successful cases. The mean diameter of unsuccessful reduction was found 4.07 cm while 2.66 cm in patients with successful reduction. In 22 patients treated surgically, 14 patients had lymphadenomegaly, 3 cases had Meckel's diverticulum, 1 had mass and 1 had polyp as pathological lead point. CONCLUSİON: Ultrasound-guided hydrostatic reduction is a simple, effective and reliable method applied to patients for non-surgical treatment of intussusception. Ultrasound-guided hydrostatic reduction should be considered as the first treatment option in patients with intussusception. We tried to determine candidates for unsuccessful hydrostatic treatment based on imaging and clinical findings. Longer areas of intussusception as well as wider diameters, the presence intraabdominal fluid and enlarged lymph nodes is useful in predicting candidates for unsuccessful treatment.