WOFAPS 2025 8th World Congress of Pediatric Surgery

Yannick Braun, Till-Martin Theilen, Henning Fiegel, Udo Rolle

Department of Pediatric Surgery and Pediatric Urology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany

Purpose:
Intussusception is a common cause of acute abdominal pain in children and can often be managed non-surgically. This study aimed to evaluate the safety and effectiveness of ultrasound-guided saline enema (USGSE) for ileocolic intussusception over a 10-year period in a tertiary pediatric surgical center, and to identify clinical predictors of treatment failure and pathological lead points.

Methods:
We retrospectively analyzed data from 89 pediatric patients (93 episodes) treated for intussusception between January 2012 and December 2022. Only cases requiring intervention (USGSE or surgery) were included. Data on demographics, clinical presentation, treatment course, and outcomes were collected. Statistical analyses included Fisher’s exact test, Student’s t-test, and multivariate proportional hazard analysis, with significance set at p < 0.05.

Results:
USGSE was the first-line treatment in 91 of 93 cases (97.8%) and was successful in 70 cases (77%), with no major complications reported. Surgery was required in 21 cases after insufficient reduction by USGSE, with pathological lead points identified in 61.9%. Among all cases, 21.5% had a pathological lead point. When excluding these, the USGSE success rate was as high as 89.0%. Symptom duration >24 hours and presence of bloody stool significantly predicted USGSE failure in typical cases (p<0.05). Failed USGSE and older patient age were significantly associated with the presence of a pathological lead point (p<0.05).

Conclusion:
USGSE is a safe and effective treatment for ileocolic intussusception in children, with high success rates and no major adverse events. Prolonged symptoms and bloody stools predict USGSE failure in typical cases, while failed USGSE and older age strongly correlate with pathological lead points. Thorough evaluation is essential following unsuccessful reduction to rule out underlying pathology.