The Journal of surgical research · 2025
Delay of Ileocolic Intussusception Reduction is Safe and May Confer Benefit.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Schuh Jennifer M, Hilt Lauren, Bergner Carisa, Boyd Kevin, Van Arendonk Kyle, Wagner Amy J
Аннотация
INTRODUCTION: The management of ileocolic intussusception has evolved through the years. This retrospective observational study examined the relationship of time to initial reduction on outcomes and the implementation of a guideline standardizing selective, delayed repeat imaging and fluoroscopic reduction.
MATERIALS AND METHODS: All ileocolic intussusception encounters 5 y prior to and 21 mo after practice guideline implementation (June 2022) were identified. Outcomes included spontaneous reduction, need for surgery, type of surgery (laparoscopy versus laparotomy), need for bowel resection, 30-d emergency department visits, 30-d readmission rate, and administration of intravenous pain medication (a guideline compliance metric).
RESULTS: Among 243 included encounters (181 preguideline and 50 postguideline implementation), 164 patients had an initially successful fluoroscopic reduction. Twenty-two patients had a partially successful initial reduction (18 preguideline and 4 postguideline). Neither delay of initial ileocolic reduction attempt nor guideline implementation for selective repeat reduction attempt was associated with need for operation, need for resection, 30-d emergency department visits nor 30-d readmission rate. More patients received intravenous pain medication postguideline.
CONCLUSIONS: Neither increased time to initial fluoroscopic reduction of ileocolic intussusception nor guideline implementation for selective repeat delayed reduction attempt are associated with poor patient outcomes and may confer benefit as it allows for spontaneous reduction. The need for surgical intervention among patients with initial partial fluoroscopic reduction of intussusception can frequently be obviated using delayed repeat ultrasound and repeat fluoroscopic reduction attempts.
MATERIALS AND METHODS: All ileocolic intussusception encounters 5 y prior to and 21 mo after practice guideline implementation (June 2022) were identified. Outcomes included spontaneous reduction, need for surgery, type of surgery (laparoscopy versus laparotomy), need for bowel resection, 30-d emergency department visits, 30-d readmission rate, and administration of intravenous pain medication (a guideline compliance metric).
RESULTS: Among 243 included encounters (181 preguideline and 50 postguideline implementation), 164 patients had an initially successful fluoroscopic reduction. Twenty-two patients had a partially successful initial reduction (18 preguideline and 4 postguideline). Neither delay of initial ileocolic reduction attempt nor guideline implementation for selective repeat reduction attempt was associated with need for operation, need for resection, 30-d emergency department visits nor 30-d readmission rate. More patients received intravenous pain medication postguideline.
CONCLUSIONS: Neither increased time to initial fluoroscopic reduction of ileocolic intussusception nor guideline implementation for selective repeat delayed reduction attempt are associated with poor patient outcomes and may confer benefit as it allows for spontaneous reduction. The need for surgical intervention among patients with initial partial fluoroscopic reduction of intussusception can frequently be obviated using delayed repeat ultrasound and repeat fluoroscopic reduction attempts.