Management of intussusception in children: When to observe, when to non-surgically reduce, and when to operate?

Objective: To evaluate demographic characteristics, treatment approaches, and outcomes of children diagnosed with intussusception via ultrasound (US) and develop
an algorithm for managing these children.
Materials and Methods: Sixty-five patients diagnosed between 2020 and 2023 were evaluated. Length of invaginated segment, clinical findings, treatment approach,
time from onset of symptom to admission, and results were examined.
Results: Median age was 34 months (range 2-156) (27 females, 38 males). Patients were grouped as follows: Group 1: Medical follow-up and treatment (n=24), median
presentation time: 30.5 hours (8-48), median invaginated segment length: 32.5 mm (12-65). Group 2: Hydrostatic or contrast reduction under US/fluoroscopy (n=21),
median presentation time: 24 hours (8-48), median invaginated segment length: 50 mm (20-120). Group 3: Emergency surgery (n=20), median presentation time: 36
hours (12-100), median invaginated segment length: 46 mm (20-100). Segment lengths of Group 1 and Groups 2 and 3 differed significantly (p=0.001, p=0.002). There
was a significant difference in presentation time between Groups 2 and 3 (p=0.035), but not between Group 1 and the rest. Hydrostatic reduction failed in six patients
in Group 2, requiring surgery. In Group 3, most patients undergoing surgery were reduced manually, but four required resection.
Conclusion: Intussusception can be transient in some cases. Intermittent US is an appropriate approach, especially for intussusceptions shorter than 32.5 mm. For
longer segments, if the patient's general condition is good, hydrostatic reduction should be the preferred approach. However, in cases having serious clinical findings
such as late presentation, palpation of abdominal masses, or presence of “currant jelly” stool, surgical intervention should be performed without delay.
Keywords: Children, hydrostatic reduction, intussusception, ultrasound