Risk factors of bowel perforation during hydrostatic enema reduction for paediatric intussusception

• Published in: Annals of medicine (Helsinki) 2024-12, Vol.56 (1), p.2417181
• Main Authors: Tang, Xiao Bing, Liu, Shu Ting, Wu, Qian Yun, Li, Yi Feng, Ma, Xin, Bai, Yu Zuo
• Format: Article
• Language: English
• Subjects: Enema - adverse effects; Enema - methods; Female; Humans; Hydrostatic Pressure; Infant; Intestinal Perforation - etiology; intussusception; Intussusception - etiology; Intussusception - therapy; Male; paediatric perforation; Retrospective Studies; Risk Factors; Ultrasonography, Interventional; ultrasound-guided hydrostatic enema reduction
• ISSN: 0785-3890; 1365-2060; 1365-2060
• DOI: 10.1080/07853890.2024.2417181

Bowel perforation is a major, yet unstudied complication of ultrasound-guided hydrostatic enema reduction (UGHR). In this study, we aimed to explore the risk factors and determine the clinical characteristics of bowel perforation during UGHR for paediatric intussusception (P-UGHR). We retrospectively analysed the medical records of patients who underwent UGHR for intussusception at our institution between January 2011 and December 2021. The patients were divided into the P-UGHR and no P-UGHR groups. Univariate and multivariate logistic regression analyses were performed to analyse the risk factors for P-UGHR, and the clinical characteristics of patients with P-UGHR were determined. The final analysis included 4961 intussusception episodes. We identified 15 patients [eight male (53.3%); median age, 8.73 months; age range, 3-17 months] with P-UGHR. All P-UGHR cases involved colonic perforations without necrosis distal to the intussusception mass. The perforations were located in the ascending [40% (6/15)], transverse [46.7% (7/15)] or descending colon [13.3% (2/15)]. Age ≤10.5 months [odds ratio (OR), 3.636; 90% confidence interval (CI), 1.274-10.38;  = 0.043], bloody stools (OR, 4.189; 90% CI, 1.352-12.978;  = 0.037) and symptom duration >17.5 h (OR, 0.188; 90% CI, 0.053-0.666;  = 0.03) were independent risk factors for P-UGHR. Age ≤10.5 months, bloody stools and symptom duration >17.5 h were independent risk factors for P-UGHR. Caution should be exercised during UGHR in patients aged ≤10.5 months, with bloody stools or symptom duration >17.5 h.