Eight hundred children were diagnosed as intussusception in the pediatric department of our hospital from January 2019 to January 2021. The average follow-up time was 12 months. A total of 49 children were excluded from the study according to the exclusion criteria, including 18 children with intestinal perforation or peritonitis, and 31 children with missing data. A total of 751 children were finally included in the analysis, including 380 patients in the PH group and 371 patients in the MPH group.
The baseline characteristics of all patients with intussusception were shown in Table 1. The male to female ratio is about 2.07:1. The median age of the patients was 23 months and the mean weight was 12.59 kg. The median duration of symptoms was about 26 hours. The most common clinical symptoms were abdominal pain (609 cases, 81.09%), vomiting (468 cases, 62.32%) and rectal bleeding (150 cases, 19.97%). There were 63 cases of distension (8.39%), 46 cases of diarrhea (6.13%), 56 cases of constipation (7.46%) and 320 cases of palpable mass (42.61%). The mean temperature white blood cell count, neutrophils, sodium, potassium and chlorine were 37.10 ℃, 8.63*109 /L, 47.95%, 137.86 mmol/l, 3.91 mmol/l and 103.77 mmol/l, respectively. During the process of reduction, 648 cases (86.28%) and 103 cases (13.72%) were found in the right abdomen and the left abdomen respectively. Three hundred and twenty-six patients (56.59%) underwent pneumatic reduction and 425 cases (43.41%) underwent hydrostatic reduction. There were no significant differences in baseline characteristics between the PH group and the MPH group.
Table 1
Baseline characteristics of the study population and outcomes of reduction.
Group | PH group, n(%) N = 380 | MPH group, n(%) N = 371 | P-Value |
Sex | | | 0.760 |
Male | 258(67.89%) | 248(66.85%) | |
Female | 122(32.11%) | 123(33.15%) | |
Age (month)a | 21.50(10.00–34.00) | 24.00(13.00–33.00) | 0.380 |
Weight (Kg)b | 12.44(3.95) | 12.75(3.69) | 0.268 |
Abdominal pain | 302(79.47%) | 307(82.75%) | 0.252 |
Vomiting | 236(62.11%) | 232(62.53%) | 0.904 |
Rectal bleeding | 77(20.26%) | 73(19.68%) | 0.881 |
DOS (hours)a | 26.00(18.00–34.00) | 27.00(17.00–36.00) | 0.274 |
Distension | 33(8.68%) | 30(8.09%) | 0.768 |
Diarrhea | 21(5.53%) | 25(6.74%) | 0.490 |
Constipation | 33(8.68%) | 23(6.20%) | 0.195 |
Temperature (°C)b | 37.08(0.47) | 37.12(0.46) | 0.202 |
Palpable mass | 153((40.26%) | 167(45.01%) | 0.215 |
WBC count (/mm3)b | 8.60(5.10) | 8.65(5.14) | 0.880 |
Neutrophils (%)b | 47.89(13.99) | 48.01(14.15) | 0.914 |
Na (mmol/l)b | 137.61(11.60) | 138.12(9.97) | 0.515 |
K (mmol/l)b | 3.90(0.36) | 3.91(0.35) | 0.648 |
Cl (mmol/l)b | 105.00(4.86) | 102.50(4.10) | 0.320 |
Location of the mass | | | 0.852 |
Left side | 53(13.95%) | 50(13.48%) | |
Right side | 327(86.05%) | 321(86.76%) | |
Method of reduction | | | 0.774 |
Pneumatic reduction | 163(42.89%) | 163(43.94%) | |
Hydrostatic reduction | 217(57.11%) | 208(56.04%) | |
Time of radiation exposure(s)b | 155.53(30.34) | 112.67(30.29) | < 0.001 |
Time of hydrostatic reduction(s)b | 267.71(40.17) | 222.69(53.18) | < 0.001 |
Volume of normal saline(ml)b | 3773.04(686.86) | 3278.61(519.53) | < 0.001 |
Success rate | 361(95.00%) | 363(97.84%) | 0.036 |
Failure rate | 19(5.00%) | 8(2.16%) | |
Perforation | 1(0.26%) | 0(0.00%) | 0.318 |
Recurrence | 12(3.16%) | 10(2.70%) | 0.707 |
Notes: aMedian, interquartile range; bmean, standard deviation. |
Abbreviation: DOS, Duration of symptoms. WBC, white blood cell count. |
The time of radiation exposure time and reduction in PH group (155.53 ± 30.34 s, 267.71 ± 40.17 s, respectively) were significantly higher than those in MPH group (112.67 ± 30.29 s, 222.69 ± 53.18 s, respectively) (p < 0.001), and the volume of normal saline used in PH group (3773.04 ± 686.86 ml) was significantly higher than that in MPH group (3278.61 ± 519.53 ml) (p < 0.001). The success rate of reduction in MPH group (363 cases, 97.84%) was significantly higher than that in PH group (361 cases, 95.00%) (p = 0.036). There was 1 case (0.26%) of perforation who underwent surgery and 12 cases (3.16%) of recurrence In PH group, while there was no perforation and 10 cases (2.70%) of recurrence in PH group. There were no statistical differences in perforation rate and recurrence rate between the two groups. All the 22 patients with recurrence were cured by the second reduction and 1 case (0.27%) in MPH group who suffered from three recurrences was cured by the third hydrostatic reduction.
The outcomes of the failure cases who underwent surgery were shown in Table 2. In PH group, 18 cases (94.74%) were ileocolic type of intussusception and 1 cases (5.26%) were ileoileocolic type, while all the 8 cases in MPH group were ileocolic type. The idiopathic intussusception in PH group (10 cases, 52.63%) was significantly higher than that in MPH group (1 cases, 12.50%) (p = 0.030). The secondary factors were michael diverticulum (9 cases, 1.20%), intestinal polyp (3 cases, 0.40%), intestinal duplication (2 cases, 0.27%), lymphoma (1 cases, 0.13%) and intestinal angioma (1 cases, 0.13%), respectively. Ten case (52.63%) received simple reduction and 9 cases (47.37%) received intestinal anastomosis in PH group. The cases of idiopathic intussusception and lymphoma (25.00%) received simple reduction and the remaining 6 cases (75.00%) received intestinal anastomosis in MPH group (0.191). All the patients were eventually discharged and made uneventful recoveries after the surgery.
Table 2
Outcomes of the failure cases with intussusception.
Group | PH group, n(%) N = 19 | MPH group, n(%) N = 8 | P-Value |
The types of intussusception | | | 0.331 |
Ileocolic | 18(94.74%) | 8(100.00%) | |
Ileoileocolic | 1(5.26%) | 0(0.00%) | |
Etiology | | | 0.030 |
Idiopathic | 10(52.63%) | 1(12.50%) | |
Intestinal polyp | 2(10.53%) | 1(12.50%) | |
Michael diverticulum | 5(26.32%) | 4(50.00%) | |
Intestinal duplication | 1(5.26%) | 1(12.50%) | |
Lymphoma | 0(0.00%) | 1(12.50%) | |
Intestinal angioma | 1(5.26%) | 0(0.00%) | |
The method of operation | | | 0.191 |
Simple reduction | 10(52.63%) | 2(25.00%) | |
Intestinal anastomosis | 9(47.37%) | 6(75.00%) | |
Enterostomy | 0(0.00%) | 0(0.00%) | |