Risk factors associated with the outcomes of fluoroscopy guided pneumatic enema reductions of intussusceptions

SA Journal of Radiology ISSN: (Online) 2078-6778, (Print) 1027-202X Page 1 of 8 Original Research Risk factors associated with the outcomes of fluoroscopy guided pneumatic enema reductions of intussusceptions Authors: Cornelia M. Kamffer1 Hilge du Preez2 Jacques Janse van Rensburg1 Affiliations: 1 Department of Clinical Imaging Sciences, Faculty of Health Sciences, University of the Free State and Universitas Academic Hospital, Bloemfontein, South Africa Department of Paediatric Surgery, Faculty of Health Sciences, University of the Free State and Universitas Academic Hospital, Bloemfontein, South Africa 2 Corresponding author: Cornelia Kamffer, Dates: Received: 30 Mar. 2025 Accepted: 13 July 2025 Published: 18 Sept. 2025 How to cite this article: Kamffer CM, Du Preez H, Janse van Rensburg JJ. Risk factors associated with the outcomes of fluoroscopy guided pneumatic enema reductions of intussusceptions. S Afr J Rad. 2025; 29(1), a3155. https://doi.org/10.4102/sajr. v29i1.3155 Copyright: © 2025. The Authors. Licensee: AOSIS. This work is licensed under the Creative Commons Attribution License. Background: Intussusception is a common cause of paediatric bowel obstruction requiring urgent management to prevent ischaemia. Fluoroscopy-guided air enema reduction (FGAR) is the standard non-surgical treatment for uncomplicated cases. Objectives: To identify factors associated with FGAR outcomes in paediatric intussusception. Method: A retrospective analytical study was conducted at Universitas Academic Hospital, Bloemfontein, South Africa, including 110 patients with radiologically confirmed intussusception from November 2016 to December 2022. Data encompassed demographics, clinical presentation, laboratory results, and imaging findings. Results: Among 110 cases (median age 7 months, symptom duration 2 days), 37 were primarily surgically managed, while 73 underwent FGAR attempts (31 successful, 42 unsuccessful, requiring surgery). Of the 79 surgical cases, 24 had manual reduction without resection. Unsuccessful FGAR was significantly associated with younger age (p = 0.0249), dehydration (p = 0.0299), ascites (p = 0.0172), and increased outer wall intussusception diameter on ultrasound (p = 0.0026). Conclusion: In this South African cohort, unsuccessful FGAR was linked to younger age, dehydration, ascites, and larger intussusception size on ultrasound. Early recognition and routine ultrasound use are critical in resource-limited settings to enhance non-surgical outcomes and reduce surgical burden. Contribution: This study identifies predictors of FGAR failure in a low-resource context, informing clinical decision-making and addressing a gap in the literature on intussusception management in low- and middle-income countries. Keywords: intussusception; paediatric radiology; enema reduction; risk factors; paediatric emergencies; middle income country. Introduction Intussusception is a common paediatric abdominal emergency and has been reported to occur in 1–4 out of 2000 children.1,2 It is the most common cause of small bowel obstruction in children under the age of 2 years.1,2 It requires rapid diagnosis and management to prevent significant morbidity and mortality. An intussusception occurs ‘when a segment of bowel (the intussusceptum) invaginates into an adjacent segment (the intussuscipiens)’.1,3 This leads to venous congestion and oedema of the bowel wall. Well-described causes, pathophysiology and positions in which intussusceptions occur exist in the literature.4 The internationally recommended standard of management of an uncomplicated intussusception is a non-surgical enema reduction using radiological imaging guidance in the absence of contraindications, with international reported success rates of between 60% and 90%.5,6 The absolute contraindications for fluoroscopy-guided air enema reduction (FGAR) are sepsis, peritonitis, shock or haemodynamic instability and bowel perforation.5 The total intussusception mortality rates in high-income countries are less than 1% compared to 8.4% – 28% in some low-income countries.7 Read online: Scan this QR code with your smart phone or mobile device to read online. There is still a discrepancy in management between outcomes in high-income countries compared to low-income countries, primarily because of the delay in presentation, diagnosis, and transport to a definitive care centre. A systematic review of 16 intussusception studies in Africa has found http://www.sajr.org.za Open Access Page 2 of 8 that 87% of the reviewed cases were managed surgically, in contrast to what is obtained in high-income countries, where the non-operative successful management rate ranges from 60% to 80%.8 Surgical management poses its own unique risk, generally increasing the length of hospital stay and placing a strain on already limited hospital resources. Although South Africa is classified as a high-middleincome country, the healthcare system’s dichotomy creates challenges similar to those in low-income countries, including delayed diagnoses and transport delays. These factors contribute to delays in initiating treatment, such as rehydration, thereby prolonging the duration of the intussusception, leading to increased vascular compromise of the bowel. Even though resources to manage patients presenting with an intussusception non-operatively at the institution where this study was conducted are available, regular failed enema reductions still occur. Limited data are available regarding the factors associated with the outcomes of pneumatic reductions of intussusceptions in the South African population. This study aimed to address this gap in the literature. The primary objective was to determine the factors influencing outcomes of fluoroscopyguided pneumatic reductions of intussusceptions in the paediatric population and to assess the outcomes of patients admitted to this institution with intussusceptions. Research methods and design Study design and sample A retrospective analytical study was conducted at a tertiary hospital in Bloemfontein in the Free State province of South Africa. Universitas Academic Hospital is the referral hospital for paediatric surgery services required from referring health care institutes in the Free State province, the Northern Cape province and Lesotho. Patients under the age of 13 years with a radiologically confirmed intussusception from 01 November 2016 to 31 December 2022, were included. Intussusception cases that were already diagnosed and managed at other hospitals and cases with ultrasound features not suggestive of intussusception were excluded. Original Research findings were interpreted by either a radiology registrar or a paediatric surgery registrar at the time of presentation for each case. Ultrasound examinations were performed and reported by radiology registrars, ranging from the first to the final years of their postgraduate radiology training. At Universitas Academic Hospital, non-operat (...truncated)