Comparing sedative and non-sedative reduction techniques in paediatric intussusception: Insights from a 6-year study.

INTRODUCTION: Intussusception is a prevalent paediatric emergency condition. The standard of care involves the reduction using air or fluid enema is considered a safe procedure. Sedation-induced muscle relaxation thus optimising the treatment. We present a comprehensive 6- year study involving non sedative reduction (NSR) versus sedative reduction (SR) utilising ketamine and midazolam.

MATERIALS AND METHODS: A retrospective cohort study was conducted between January 2017 and July 2023 in Yogyakarta, Indonesia. A total of 85 children diagnosed with intussusception underwent hydrostatic reduction, which employed water-soluble contrast administered into the rectum. Cases that were unsuccessful in reduction underwent immediate surgical intervention.

RESULTS: Among the 85 children with intussusception underwent reduction, 22 children underwent the SR procedure and 63 underwent NSR procedure. We found a successful outcome in 17 cases (77%) of SR procedure with one recurrent and the other five (23%) got surgical reduction such as anastomosis resection (3 cases) due to Meckel- Diverticula. On the other hand, we found 24 successful cases (38.0%) in NSR procedure with one recurrent after case. 39 others who failed with NSR continued to surgical reduction. Manual reduction was done for 31 patients with one case mortality due to pulmonary bleeding. Anastomosis resection (4 cases) and, stoma (4 cases) were decided for others surgical reduction. The relative risk (RR) on this study was 2.02 (p value < 0.05, CI 95%).

CONCLUSION: Implementation of the SR procedure may reduce surgery rates in paediatric intussusception, thereby enhancing patient management. Furthermore, the success rate of hydrostatic reduction higher in under sedation procedure. We contribute to evolve insight of non-operative approaches of paediatric intussusception management, particularly in the Yogyakarta.