Use of Plane X-Ray for Nonoperative Treatment of Intussusception at Resource Limited Settings in Low-and Middle-Income Countries

Author(s): Md. Qumrul Ahsan, Tanvir Kabir Chowdhury, Tasmiah Tahera Aziz, Tahmina Banu

Objective: To report an easy and feasible technique of hydrostatic reduction of intussusception using plane x-ray in resource limited setting and summarize the radiological findings.

Method: Records of all patients of hydrostatic reduction between May 2015 and April 2020 were retrospectively evaluated to document patient demography, seasonal variations, type of intussusception, duration of procedure, number of x-ray exposures, reflux of contrast through ileocecal valve, location of intussusception mass, presence of redundant colon and outcome. Hydrostatic reduction was performed with water soluble contrast using intermittent shots of plane x-ray, instead of ultrasound (US) or fluoroscopy guidance.

Results: Among a total of 204 patients, male to female ratio was 1.7:1. Age ranged from 5 days to 16 years (median 10 months). There were more cases during Winter and Spring (110, 53.9%). Right hepatic flexure was the commonest (115, 56.4%) site of obstruction. Hydrostatic reduction was successful in 172 (84.3%) patients. Median duration of the procedure was 27 minutes and, on an average, 8.4 ± 1.7 exposures were needed for one hydrostatic reduction. There was no significant relation of age group and sex with successful hydrostatic reduction but site of obstruction was significantly related with success (p=0.00). There was one (0.5%) recurrence and no mortality.

Conclusion: Hydrostatic reduction using contrast enema under x-ray guidance is a rational alternative to US or fluoroscopy guided reduction in resource limited settings.