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Non-operative reduction has emerged as first line in the management of uncomplicated intussusception. The aim of this study was to compare the outcome of ultrasound-guided saline hydrostatic reduction and ultrasound-guided pneumatic reduction of intussusception in infants. This is a prospective study of infants with uncomplicated intussusception confirmed by ultrasound over a period of 21 months from December 2018 to August 2020. Fifty-two (69.3%) out of seventy-five infants were eligible and randomized based on simple random sampling technique into two groups: Group A included patients who had ultrasound-guided hydrostatic (saline) reduction; Group B included patients who had ultrasound-guided pneumatic (air) reduction. The success rates, time to reduction and complication rates were assessed. The success rates, between the saline hydrostatic reduction group and pneumatic reduction group, were comparable [17 (65.4%) versus 19 (73.1%); relative risk (RR) 0.8; 95% confidence interval (CI) 0.6–1.2; p  = 0.54]. The mean time to reduction was higher in the saline hydrostatic reduction group (15.4 ± 5.1 min versus 10.8 ± 4.1 min; p  = 0.003). There was no statistically significant difference in the perforation and recurrence rates between the two groups. Conclusion : Saline hydrostatic reduction and pneumatic reduction of uncomplicated intussusception under ultrasound guidance in infants might have comparable outcomes. However, pneumatic reduction may be faster. What is Known: • Ileocolic intussusception is the most common cause of intestinal obstruction in infants. • Ultrasonography is useful in the diagnosis and non-operative treatment of ileocolic intussusception. What is New: • Ultrasound-guided hydrostatic enema and ultrasound-guided pneumatic enema are similarly effective and safe techniques in the reduction of ileocolic intussusception. • Reduction of ileocolic intussusception under ultrasound guidance is a great technique that may prove useful in the developing world due to lower cost of required equipment.

Background Air enema reduction is the primary non-surgical intervention for pediatric intussusception. The aim of this study was to determine if rapid-cycle deliberate practice (RCDP) with an ex vivo model of intussusception is more effective than traditional teaching methods (TTM) for improving radiology residents’ air enema reduction competency. Methods In this randomized controlled trial, 24 radiology residents were assigned to training with an ex vivo model of intussusception combined with RCDP (the RCDP group, n  = 12) or without RCDP (the TTM group, n  = 12). Both groups underwent assessments of theoretical knowledge and practical skills before and after training in air enema reduction, followed by evaluation of indicators of competency. Satisfaction with training and self-confidence surveys were also completed. Results Pre-training assessments showed that baseline performance was comparable between the two groups (both P  > 0.05). Post-training, both groups showed improvement from baseline (both P  < 0.05), with the RCDP group demonstrating more pronounced improvement than the TTM group (RCDP: effect sizes = 2.06 and 1.94, TTM: effect sizes = 1.16 and 1.20). Furthermore, after training, mean theoretical and practical evaluation scores were significantly better in the RCDP group than in the TTM group ( 88.67 ± 5.88 vs. 82.41 ± 7.31, P  = 0.031 and 89.17 ± 4.64 vs. 80.92 ± 6.65, P  = 0.048, respectively), with a shorter mean procedural time (74.26 ± 8.25 s vs.133.41 ± 9.07 s, P  = 0.044) and a lower mean reduction pressure (5.83 ± 0.27 kPa vs. 6.40 ± 0.10 kPa, P  = 0.023). Residents in the RCDP group reported higher satisfaction scores (mean 4.58 ± 0.42 vs. 3.16 ± 0.38, P  = 0.024) and higher self-confidence scores ( P  = 0.036). Conclusions RCDP simulation is superior to TTM for training residents in air enema reduction skills. It is an effective simulation teaching method that offers a novel perspective for innovative instruction on the skills required to perform this complex clinical procedure.

Background This study aimed to evaluate the efficacy of glucocorticoids in reducing short-term recurrence rate of idiopathic intussusception in pediatric patients. Methods A retrospective cohort study was conducted on children with recurrent idiopathic intussusception treated at the Emergency Center of Beijing Children’s Hospital from January 2015 to January 2024. Patients who experienced three episodes of intussusception within 5 days were included. After successful fluoroscopy-guided air enema (FGAE), some children received glucocorticoids (intervention group), while others did not (control group). Recurrence rates within 14 days were compared between the groups. Lastly, delayed complications and adverse effects related to glucocorticoid use were recorded. Results A total of 10,493 FGAE sessions were performed, with 206 patients initially enrolled. Ultimately, 183 patients (124 boys, 59 girls; aged 9 months to 9 years) were included. The recurrence rate was significantly lower in the intervention group compared to the control group (18.6% vs. 46.6%, P  = 0.001). Finally, no delayed complications or adverse effects related to glucocorticoid therapy were observed. Conclusions Glucocorticoids effectively reduced recurrence rate in children with short-term recurrent idiopathic intussusception without eliciting significant adverse effects.

Postlicensure data has identified a causal link between rotavirus vaccines and intussusception in some settings. As rotavirus vaccines are introduced globally, monitoring intussusception will be crucial for ensuring safety of the vaccine programs. To obtain updated information on background rates and clinical management of intussusception, we reviewed studies of intussusception in children <18 years of age published since 2002. We assessed the incidence of intussusception by month of life among children <1 year of age, seasonality, method of diagnosis, treatment, and case-fatality. We identified 82 studies from North America, Asia, Europe, Oceania, Africa, Eastern Mediterranean, and Central & South America that reported a total of 44,454 intussusception events. The mean incidence of intussusception was 74 per 100,000 (range: 9-328) among children <1 year of age, with peak incidence among infants 5-7 months of age. No seasonal patterns were observed. A radiographic modality was used to diagnose intussusception in over 95% of the cases in all regions except Africa where clinical findings or surgery were used in 65% of the cases. Surgical rates were substantially higher in Africa (77%) and Central and South America (86%) compared to other regions (13-29%). Case-fatality also was higher in Africa (9%) compared to other regions (<1%). The primary limitation of this review relates to the heterogeneity in intussusception surveillance across different regions. This review of the intussusception literature from the past decade provides pertinent information that should facilitate implementation of intussusception surveillance for monitoring the postlicensure safety of rotavirus vaccines.

Despite the benefits of rotavirus vaccination, concerns about intussusception are an important consideration. In this study, the risk of intussusception associated with rotavirus vaccination was assessed in African countries in which the vaccine had recently been rolled out.

Background Intussusception is the leading cause of acute abdominal conditions in infants, yet it is frequently under-recognised in those younger than 3 months, potentially resulting in serious complications such as bowel necrosis, peritonitis, or even death if not promptly treated. This retrospective study aims to enhance clinicians’ understanding of the diagnosis and management of acute intussusception in this age group to prevent poor prognosis. Methods The clinical data of 38 infants aged ≤ 3 months diagnosed with intussusception at Wuhan Children’s Hospital between January 2013 and July 2024 were retrospectively analyzed. Patients were categorized into two groups based on the outcome of nonoperative reduction: the successful group and the failed group. The study examined demographic characteristics, clinical presentations, imaging findings, treatment modalities, and outcomes to identify patterns and evaluate the effectiveness of diagnostic and therapeutic approaches. Results During the study period, 12,206 children were diagnosed with intussusception, including 38 (0.31%) infants aged 3 months or younger (mean age: 73.6 days; 20 males and 18 females). The most frequently reported symptoms were vomiting (36 cases), bloody stool (27 cases), and intermittent crying (18 cases). Ultrasonography (USG) confirmed the diagnosis in 97.4% of cases. A total of 27 (71.1%) infants treated with enema reduction, with a success rate of 48.1% (13/27). Enema-related perforation occurred in 2 cases (7.4%). An additional 11 cases (28.9%) proceeded directly to laparotomy, with 5 (15.8%) diagnosed as secondary intussusception. Bowel resection was necessary in 6 of the 25 surgical cases due to necrosis. Each infant responded well to treatment and was discharged in stable condition. Conclusions The clinical manifestations of intussusception in infants aged 3 months and below are sometimes atypical. Early USG should be performed to make a clear diagnosis, and the effect of early intervention is satisfactory. In infants with good general condition, enema reduction can be attempted first with appropriate pressure monitoring to avoid bowel perforation.

Intussusception is a common etiology of acute abdominal pain in children. Over the last 70 years, there have been significant changes in how we diagnose and treat intussusception, with a more recent focus on the role of ultrasound. In this article we discuss historical and current approaches to intussusception, with an emphasis on ultrasound as a diagnostic and therapeutic modality.

Pediatric intussusception is a serious condition that carries with it a high risk of morbidity and mortality. This review highlights the pearls and pitfalls of pediatric intussusception, including the presentation, diagnosis, and management in the emergency department (ED) based on current evidence. Intussusception is one of the most common pediatric abdominal emergencies. This is associated with one part of the intestine telescoping into another, resulting in bowel edema. If the intussusception remains untreated, obstruction, ischemia, necrosis, and perforation may result. Most cases are idiopathic, with 10–25 % associated with a pathologic mass or lead point. The most common age group affected includes those between 3 months to 5 years. The triad of intermittent abdominal pain, currant jelly stool, and sausage-shaped mass is uncommon, though most patients will present with intermittent abdominal pain. Nonbilious emesis and bloody stools (gross blood or guaiac positive) are also common. Younger patients can present atypically, including altered mental status or lethargy. Thus, intussusception should be considered in pediatric patients with abdominal pain, emesis, and a sausage-shaped mass, as well as those with atypical presentations such as altered mental status or lethargy if there is no other etiology found on testing. The diagnostic modality of choice is ultrasound. Plain radiography may assist in evaluating for obstruction and perforation. Treatment includes prompt reduction of the intussusception. In patients who are stable and have no evidence of perforation, non-operative reduction with hydrostatic or pneumatic reduction should be attempted. Operative intervention is necessary in those who are unstable, peritonitic, or have a focal lead point. Discharge may be appropriate for patients following successful non-operative reduction if the patient is able to tolerate clear fluids, is asymptomatic, and can return for any recurrence of symptoms. An understanding of pediatric intussusception and its many potential mimics can assist emergency clinicians in diagnosing and managing this high risk disease.

We conducted a comprehensive meta-analysis to compare the effectiveness and safety of fluoroscopy-guided air enema reduction (FGAR) and ultrasound-guided hydrostatic enema reduction (UGHR) for the treatment of intussusception in pediatric patients. A systematic review and meta-analysis were conducted on retrospective studies obtained from various databases, including PUBMED, MEDLINE, Cochrane, Google Scholar, China National Knowledge Infrastructure (CNKI), WanFang, and VIP Database. The search included publications from January 1, 2003, to March 31, 2023, with the last search done on Jan 15, 2023. We included 49 randomized controlled studies and retrospective cohort studies involving a total of 9,391 patients, with 4,841 in the UGHR and 4,550 in the FGAR. Specifically, UGHR exhibited a significantly shorter time to reduction (WMD = -4.183, 95% CI = (-5.402, -2.964), P < 0.001), a higher rate of successful reduction (RR = 1.128, 95% CI = (1.099, 1.157), P < 0.001), and a reduced length of hospital stay (WMD = -1.215, 95% CI = (-1.58, -0.85), P < 0.001). Furthermore, UGHR repositioning was associated with a diminished overall complication rate (RR = 0.296, 95% CI = (0.225, 0.389), P < 0.001) and a lowered incidence of perforation (RR = 0.405, 95% CI = (0.244, 0.670), P < 0.001). UGHR offers the benefits of being non-radioactive, achieving a shorter reduction time, demonstrating a higher success rate in repositioning in particular, resulting in a reduced length of postoperative hospital stay, and yielding a lower overall incidence of postoperative complications, including a reduced risk of associated perforations.

BackgroundImage-guided reduction of intussusception is considered a radiologic urgency requiring 24-h radiologist and technologist availability.ObjectiveTo assess whether a delay of 6–12 h between US diagnosis and fluoroscopic reduction of ileocolic intussusception affects the success frequency of fluoroscopic reduction.Materials and methodsRetrospective review of 0–5-year-olds undergoing fluoroscopic reduction for ileocolic intussusception from 2013 to 2023. Exclusions were small bowel intussusception, self-reduced intussusception, first fluoroscopic reduction attempt>12 h after US, prior bowel surgery, inpatient status, and patient transferred for recurrent intussusception. Data collected included demographics, symptoms, air/contrast enema selection, radiation dose, reduction failure, 48-h recurrence, surgery, length of stay, and complications. Comparisons between<6-h and 6–12-h delays after ultrasound diagnosis were made using chi-square, Fisher’s exact test, and Mann–Whitney U tests (P< 0.05 considered significant).ResultsOf 438 included patients, 387 (88.4%) were reduced in <6 h (median age 1.4 years) and 51 (11.7%) were reduced between 6 and 12 h (median age 2.05 years), with median reduction times of 1:42 and 7:07 h, respectively. There were no significant differences between the groups for reduction success (<6 h 87.3% vs. 6–12 h 94.1%; P-value = 0.16), need for surgery (<6 h 11.1% vs. 6–12 h 3.9%; P-value=0.112), recurrence of intussusception within 48 h after reduction (<6 h 9.3% vs. 6–12 h 15.7%; P-value=0.154), or length of hospitalization (<6 h 21:07 h vs. 6–12 h 20:03 h; P-value=0.662).ConclusionA delay of 6–12 h between diagnosis and fluoroscopic reduction of ileocolic intussusception is not associated with reduced fluoroscopic reduction success, need for surgical intervention after attempted reduction, recurrence of intussusception following successful reduction, or hospitalization duration after reduction.