AAP Papers
Is it safe to discharge intussusception patients after successful hydrostatic reduction?

https://doi.org/10.1016/j.jpedsurg.2010.02.085Get rights and content

Abstract

Purpose

The aim of this study was to evaluate whether discharge from the emergency department (ED) after successful hydrostatic reduction (HR) of intussusception is safe.

Methods

We conducted a single institution review of patient records with a diagnosis code of intussusception from 1995 to 2006. Data collected included age, clinical presentation, imaging, surgical interventions, pathology, recurrence, and disposition. Statistical analysis utilized χ2 tests, where P ≤ .05 was considered significant.

Results

A total of 309 patients with intussusception were identified. One hundred twenty-three patients (39.8%) required surgical intervention, 138 (44.6%) patients were managed nonoperatively as inpatients, and 48 (15.5%) were treated nonoperatively and discharged from the ED. There were 18 recurrences (5.8%). Recurrence rates did not significantly differ between patients who required operative reduction and those who were managed nonoperatively with HR and either observed as inpatients or discharged from the ED. Seven patients with recurrences required surgical intervention, and 1 of those children had a pathologic lead point, which was nonneoplastic.

Conclusions

Recurrence rates do not differ between children observed as inpatients and those discharged home after successful HR. Missed neoplastic pathologic lead points were not found in the patients who required an operation after a recurrence. Our data suggests that it is safe to discharge patients selectively from the ED after successful HR.

Section snippets

Methods

This study was approved by the Children's Hospital of Wisconsin Institutional Review Board (#06/185, GC #246). Medical records of patients 0 to 18 years of age with the diagnosis of intussusception from 1995 to 2006 were reviewed. Asymptomatic patients with incidentally found intussusceptions on axial imaging were excluded if no further intervention for the intussusception occurred. Data collected included age, presenting symptoms and physical examination findings, diagnostic studies, surgical

Results

A total of 309 patients with the diagnosis of intussusception were identified. Of these, 261 (84.5%) patients were admitted to the hospital, including 123 (39.8%) that required surgical intervention and 138 (44.6%) who were admitted to the hospital after successful HR for observation. Of the 138 patients observed as inpatients after successful HR, 73 were admitted to the surgical service and 65 were admitted to a pediatric service. The average length of stay for the patients observed as

Discussion

Intussusception remains a leading cause of acute abdominal pain in young children [4]. Surgical recommendations include in-hospital observation for 48 hours after reduction [1]. Justifications for this include the high risk of recurrence within 48 hours after reduction, possible enema-related complications, and the need for serial abdominal examinations to monitor for segmental ischemia of the intussusceptum. A few studies have found that discharge from the ED after successful HR is safe in

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