Objectives

Outcomes of ultrasound-guided saline enema include successful treatment, unsuccessful treatment, or recurrence. This study aimed to investigate the value of ultrasonic parameters of the ileocecal region during hydrostatic reduction to predict enema outcomes.

Methods

Ultrasound images of patients diagnosed with ileocolic intussusception and treated with ultrasound-guided saline enema at two different institutions between January 2019 and April 2021 were retrospectively analyzed to assess ileocecal-valve diameter (ICVD), intussusceptum thickness (IT), and the ratio of IT to ICVD (I/I). Logistic regression analysis was used to explore correlations between ICVD, IT, I/I, and patient characteristics (sex, age, symptom duration, and enema outcome).

Results

Of 291 patients with ileocolic intussusception (207 boys; mean ICVD, 8.6 [SD: 0.1] mm; mean IT, 26 [SD: 0.2] mm; mean I/I, 3.0 [SD: 0.01]), 268 had first successful reduction; 23, first failed reduction; 7, final failed reduction; and 41, early recurrence. Significant risk factors for failed reduction included symptom duration >24 hours (odds ratio [OR] = 10, P = .012), ICVD ≤ 8.5 mm (OR = 8, P = .01), and I/I > 3.25 (OR = 16, P < .001). Significant risk factors for early recurrence post-enema included age >1 year (OR = 10, P = .028), ICVD > 8.5 mm (OR = 4, P = .003), and I/I ≤ 2.95 (OR = 6, P < .001).

Conclusions

ICVD and IT measured during ultrasound-guided hydrostatic reduction can predict enema outcomes. The mismatch between IT and ICVD is the primary cause of poor outcomes.