SONOGRAPHICALLY GUIDED HYDROSTATIC REDUCTION OF CHILDHOOD INTUSSUSCEPTION USING HARTMANNS SOLUTION

OBJECTIVE. Currently, the standard methods for therapeutic reduction o f intussusception in children involve considerable ionizing radiation. This study tested the effectiveness of sonographically guided hydrost atic reduction of intussusception using Hartmann's solution, a fluid w ith near-physiologic composition. SUBJECTS AND METHODS. Between March 1, 1994, and January 31, 1996, all children clinically suspected of ha ving intussusception were evaluated by sonography. Those with positive findings on sonography were entered into the study and underwent conf irmatory sonographically guided meglumine diatrizoate enema. During co ntinuous sonographic monitoring, we used Hartmann's solution for attem pted reduction of intussusception. Criteria for successful reduction w ere disappearance of the intussusceptum and passage of fluid through t he ileocecal valve. Another Sonographically guided meglumine diatrizoa te enema was used to confirm successful reduction. RESULTS, We detecte d 25 consecutive intussusceptions in 22 patients. The patients were 12 girls and 10 boys, with a mean age of 14 months (range, 1-72 months). Sonograms revealed in all patients doughnut or pseudokidney signs or both. The sites of intussusception were the transverse colon (17 of 25 ), hepatic flexure (4 of 25), ascending colon (2 of 25), splenic flexu re (1 of 25), and descending colon (1 of 25). Other findings were dila ted fluid-filled small bowel (11 of 25) and free intraperitoneal fluid (9 of 25). The success rate of our sonographically guided attempts at hydrostatic reduction was 76% (19 of 25). Success was proven by meglu mine diatrizoate enema in all 19 patients. The mean time of the reduct ion procedure was 18 min (range, 2-45 min). No complications occurred. All six patients in whom hydrostatic reduction was unsuccessful under went Surgery. Five of these patients had ileoileocolic intussusception s. On sonography, when surrounded by fluid, ileoileocolic intussuscept ions had a typically complex, fronded appearance. The remaining patien t in whom hydrostatic reduction was unsuccessful had ileocolic intussu sception. Of six ileoileocolic intussusceptions, one was hydrostatical ly reduced and a second was converted into an ileoileal intussusceptio n before requiring surgery. The other four intussusceptions were surgi cally treated. CONCLUSION. Our data suggest that sonographically guide d hydrostatic reduction with Hartmann's solution can be used to treat ileocolic intussusception and to diagnose ileoileocolic intussusceptio n.