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Implementing ultrasound-guided hydrostatic reduction of intussusception in a low-resource country in Sub-Saharan Africa: our initial experience in Ethiopia

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Abstract

Background

Despite advances in non-invasive radiological techniques for the treatment of intussusception, management of the entity still remains exclusively surgical in many developing countries, including Ethiopia. Fluoroscopic units are rare or mostly dysfunctional. Ultrasound scanners are more commonly available. Ultrasound-guided hydrostatic reduction (USGHR) was recently introduced to the main referral hospital in Ethiopia, and subsequently has been adopted as the initial management option for intussusception.

Purpose

The aim of this study was to evaluate our experience with USGHR in Ethiopia and measure the impact on patient care.

Methods

A prospective study was conducted between July 2014 and August 2015 on all pediatric patients, with US-confirmed intussusception, at the Tikur Anbessa Specialized Teaching Hospital in Addis Ababa, Ethiopia. All patients, excluding those with signs of peritonitis, bowel ischemia, or symptoms lasting longer than 4 days, were selected to undergo USGHR.

Results

A total of 53 children were diagnosed with intussusception, confirmed via ultrasound. Following exclusion criteria, USGHR was attempted in 47 of the patients. Forty-one of the 47 patients (87.2%) had successful reduction, resulting in a 77% overall rate of successful non-operative management in all patients with intussusception.

Conclusion

The rate of operative reduction of intussusception decreased by 77% following the introduction of USGHR as the initial non-surgical intervention. Therefore, we believe USGHR should be fully implemented in our hospital, and recommend that this study serves as an example to other institutions in our country as well as in other developing countries facing similar challenges.

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References

  1. del-Pozo G, Albillos JC, Tejedor D, Calero R, Rasero M, de-la-Calle U, López-Pacheco U (1999) Intussusception in children: current concepts in diagnosis and enema reduction. Radiographics 19(2):299–319

    Article  CAS  PubMed  Google Scholar 

  2. Daneman A, Navarro O (2004) Intussusception. Part 2: an update on the evolution of management. Pediatr Radiol 34(2):97–108

    Article  PubMed  Google Scholar 

  3. Ko HS, Schenk JP, Troger J, Rohrschneider WK (2007) Current radiological management of intussusception in children. Eur Radiol 17(9):2411–2421

    Article  PubMed  Google Scholar 

  4. Kim YG, Choi BI, Yeon KM et al (1982) Diagnosis and treatment of childhood intussusception using real-time ultrasonography and saline enema: preliminary report. J Korean Soc Med Ultrasound 1:66–70

    Google Scholar 

  5. Riebel TW, Nasir R, Weber K (1993) US-guided hydrostatic reduction of intussusception in children. Radiology 188(2):513–516

    Article  CAS  PubMed  Google Scholar 

  6. Reijnen JA, Festen C, van Roosmalen RP (1990) Intussusception: factors related to treatment. Arch Dis Child 65(8):871–873

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Tareen F, Ryan S, Avanzini S, Pena V, Mc Laughlin D, Puri P (2011) Does the length of the history influence the outcome of pneumatic reduction of intussusception in children? Pediatr Surg Int 27(6):587–589

    Article  PubMed  Google Scholar 

  8. Wood SK, Kim JS, Suh SJ, Paik TW, Choi SO (1992) Childhood intussusception: US-guided hydrostatic reduction. Radiology 182(1):77–80

    Article  CAS  PubMed  Google Scholar 

  9. Betz BW, Hagedorn JE, Guikema JS, Banres CL (2013) Therapeutic enema for pediatric ileocolic intussusception: using a balloon catheter improves efficacy. Emerg Radiol 20:385–391

    Article  PubMed  Google Scholar 

  10. Lawal TA, Atalabi OM, Adekanmi AJ, Ogundoyin OO (2009) Factors influencing the practice of hydrostatic reduction of intussusception amongst radiologists in a developing country. West African Journal of Ultrasound 10:1–4

    Google Scholar 

  11. Meier DE, Coln CD, Rescorla FJ, OlaOlorun A, Tarpley JL (1996) Intussusception in children: international perspective. World J Surg 20(8):1035–1039

    Article  CAS  PubMed  Google Scholar 

  12. Hadidi AT, El Shal N (1999) Childhood intussusception: a comparative study of nonsurgical management. J Pediatr Surg 34(2):304–307

    Article  CAS  PubMed  Google Scholar 

  13. Mensah Y, Glover-Addy H, Etwire V, Appeadu-Mensah W, Twum M (2011) Ultrasound guided hydrostatic reduction of intussusception in children at Korle Bu Teaching Hospital: an initial experience. Ghana Med J 45(3):128–131

    CAS  PubMed  PubMed Central  Google Scholar 

  14. Nayak D, Jagdish S (2008) Ultrasound guided hydrostatic reduction of intussusception in children by saline enema: our experience. Indian J Surg 70(1):8–13

    Article  PubMed  PubMed Central  Google Scholar 

  15. He N, Zhang S, Ye X, Zhu X, Zhao Z, Sui X (2014) Risk factors associated with failed sonographically guided saline hydrostatic intussusception reduction in children. J Ultrasound Med 33(9):1669–1675

    Article  PubMed  Google Scholar 

  16. Hernandez JA, Swischuk LE, Angel CA (2004) Emerg Radiol 10:323–326

    PubMed  Google Scholar 

  17. Atalabi OM, Ogundoyin OO, Ogunlana DI, Onasanya OM, Lawal TA, Olarinoye AS (2007) Hydrostatic reduction of intussusception under ultrasound guidance: an initial experience in a developing country. Afr J Paediatr Surg 4(2):68–71

    Google Scholar 

  18. Tander B, Baskin D, Candan M, Basak M, Bankoglu M (2007) Ultrasound guided reduction of intussusception with saline and comparison with operative treatment. Ulus Travma Acil Cerrahi Derg 13(4):288–293

    PubMed  Google Scholar 

  19. Bai YZ, Qu RB, Wang GD, Zhang KR, Li Y, Huang Y, Zhang ZB, Zhang SC, Zhang HL, Zhou X, Wang WL (2006) Ultrasound-guided hydrostatic reduction of intussusceptions by saline enema: a review of 5218 cases in 17 years. Am J Surg 192(3):273–275

    Article  PubMed  Google Scholar 

  20. Ghribi A, Sahil S, Sghairoun N, Fitouri F, Gasmi M, Hamzaoui M (2014) Recurrent intussusception in infants. Int J Clin Pediatr 3(4):105–107

    Article  Google Scholar 

  21. Hsu WL, Lee HC, Yeung CY, Chan WT, Jiang CB, Sheu JC, Wang NL, Shih SL (2012) Recurrent intussusception: when should surgical intervention be performed? Pediatr Neonatol 53(5):300–303

    Article  PubMed  Google Scholar 

  22. Niramis R, Watanatittan S, Kruatrachue A, Anuntkosol M, Buranakitjaroen V, Rattanasuwan T, Wongtapradit L, Tongsin A (2010) Management of recurrent intussusception: nonoperative or operative reduction? J Pediatr Surg 45(11):2175–2180

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, Faculty of Medicine, Addis Ababa University, Addis Ababa, Ethiopia

    Eyasu Wakjira, Samuel Sisay, Daniel Zewdneh, Yocabel Gorfu & Tesfaye Kebede

  2. Department of Radiology, The Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA

    Jonathan Zember & Kassa Darge

  3. Department of Surgery, Faculty of Medicine, Addis Ababa University, Addis Ababa, Ethiopia

    Amezene Tadesse

Authors
  1. Eyasu Wakjira
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  2. Samuel Sisay
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  3. Jonathan Zember
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  4. Daniel Zewdneh
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  5. Yocabel Gorfu
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  6. Tesfaye Kebede
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  7. Amezene Tadesse
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  8. Kassa Darge
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Corresponding author

Correspondence to Jonathan Zember.

Ethics declarations

This was a cross-sectional prospective study, approved by the Institutional Review Board, performed over a 14-month period from July 2014 to August 2015. All parents or caretakers of the patients undergoing the procedure were informed about the procedure and requested to sign informed written consent in their local language.

Conflict of interest

The authors declare that they have no conflict of interest.

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Wakjira, E., Sisay, S., Zember, J. et al. Implementing ultrasound-guided hydrostatic reduction of intussusception in a low-resource country in Sub-Saharan Africa: our initial experience in Ethiopia. Emerg Radiol 25, 1–6 (2018). https://doi.org/10.1007/s10140-017-1546-y

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  • DOI: https://doi.org/10.1007/s10140-017-1546-y

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