Intussusceptions are the second most common cause of acute intestinal obstructions in children. Once they are diagnosed, they should be treated as early as possible. Though their exact causes are not known in most of the cases, swollen Payer’s patches, enlarged lymph nodes, polyps, Meckel’s diverticulum and duplication cysts have been suggested as few of the common aetiological factors [1
Ultrasonography is very useful investigation that can be used for the diagnosis of intussusceptions, which has a high sensitivity [98-100%] and specificity [88-100%] [5
]. The absence of blood flow in the lesion on Colour Doppler study correlates significantly with the high incidence of the complications and the irreducibility which are seen in non-surgical methods [4
]. The various diagnostic points of the intussusceptions which are seen on ultrasound and on colour Doppler [ and ] studies [2
] have been enumerated in . An ultrasound guided hydrostatic reduction with the use of normal saline is believed to be one of the most promising methods for the non-surgical treatment of paediatric intussusceptions [4
]. It is a simple, effective, economical and a less time-consuming procedure which is coupled with fewer complications (a very low perforation rate), no radiation hazards and a minimal hospital stay.
Ultrasound- T.S.-Target lesion of intussusceptions (open arrow) with few enlarged lymphnodes
Pseudokidney lesion with internal vascularity on Colour Doppler Study
Diagnostic points of intussusception on ultrasound with colour Doppler study
It is also associated with less morbidity i.e. there is no incidence of a pseudo-reduction as is seen in the fluoroscopic guided procedures; there is no fluctuation in the intra-colonic pressure as is seen in air enema; even if a perforation occurs, there are minimum chances for chemical peritonitis as it occurs with barium enema; there is no tension in the pneumo-peritoneum as is seen in air enema; there is no chance for fluid shifts as has been linked with hypertonic contrast medium solutions or tap water. The mortality rate is also nil i.e. there is no reported case of death as in air enema [4
The real time ultrasound shows the whole process of the reduction and hence, there remains no confusion about it [ and ] however, the oedematous ileocaecal valve sometimes mimics a residual intussusception. Further, a pathological lead point may be identified and even a recurrence can also be treated by the same method.
Instillation of normal saline up to intussusception (arrows)
Reducing intussusceptum (arrow) with surrounding fluid filled loops (arrow heads)
The contraindications for hydrostatic reductions include an absent or a scattered vascularity within the lesion on colour Doppler studies, evident signs of perforation and peritonitis, ascites, multiple intussusceptions and recurrent intussusceptions with known pathological lead points. However, a minimal free fluid without any signs of perforation or peritonitis is not a contraindication for a hydrostatic reduction of an intussusception.
In the present study, the clinical findings like the age and the sex of the patients, the site of the intussusception, and the mean time of the reduction were comparable to those of other studies which have been mentioned in the references [4
]. A history of gastroenteritis and upper respiratory tract infection has been reported in 20% of the patients, but in our study, the concurrence of these infections with intussusceptions was observed in 80% and 40% of the cases respectively.
In our case series, complete ultrasound guided hydrostatic reduction of the intussusceptions was achieved in 26 out of the 30 patients, with a success rate of 87%. This was similar to the findings of Krishnakumar et al., [4
] and Del Pozo G et al., [5
] where the success rate of the ultrasound guided hydrostatic reductions was more than 80%, which was somewhat more that the success rate of 78% of SA Alamdaran et al., [8
] and that of 73% which was achieved in the study of Chan KL et al. [9
]. Our results further suggest that age, duration of the symptoms, and the site of the intussusception are not the contraindications for a non-surgical reduction.
Though this technique is very useful in the recent onset intussusceptions which present within 48 hrs, the longer time lapses in the presentation should not be a contraindication in trying this method in the absence of abdominal or systemic complications [2
]. The assessment of the affected bowel loop with colour Doppler ultrasound for the presence of vascularity is an added advantage in deciding the prognostic outcome.