Risk factors associated with the outcomes of fluoroscopy guided pneumatic enema reductions of intussusceptions

Abstract

Background: Intussusception is a common cause of paediatric bowel obstruction requiring urgent management to prevent ischaemia. Fluoroscopy-guided air enema reduction (FGAR) is the standard non-surgical treatment for uncomplicated cases.
Objectives: To identify factors associated with FGAR outcomes in paediatric intussusception.
Method: A retrospective analytical study was conducted at Universitas Academic Hospital, Bloemfontein, South Africa, including 110 patients with radiologically confirmed intussusception from November 2016 to December 2022. Data encompassed demographics, clinical presentation, laboratory results, and imaging findings.
Results: Among 110 cases (median age 7 months, symptom duration 2 days), 37 were primarily surgically managed, while 73 underwent FGAR attempts (31 successful, 42 unsuccessful, requiring surgery). Of the 79 surgical cases, 24 had manual reduction without resection. Unsuccessful FGAR was significantly associated with younger age (p = 0.0249), dehydration (p = 0.0299), ascites (p = 0.0172), and increased outer wall intussusception diameter on ultrasound (p = 0.0026).
Conclusion: In this South African cohort, unsuccessful FGAR was linked to younger age, dehydration, ascites, and larger intussusception size on ultrasound. Early recognition and routine ultrasound use are critical in resource-limited settings to enhance non-surgical outcomes and reduce surgical burden.
Contribution: This study identifies predictors of FGAR failure in a low-resource context, informing clinical decision-making and addressing a gap in the literature on intussusception management in low- and middle-income countries.