Hydrostatic reduction of intussusception with intermittent radiography: an alternative to fluoroscopy or ultrasound-guided reduction in low-income and middle-income countries

BackgroundAlthough hydrostatic reduction of intussusception with ultrasound (US) or fluoroscopy guidance is well known, it is not yet well established in many low-income and middle-income countries. The aim of the study is to report our results of hydrostatic reduction with intermittent radiography, which has the potential to be practiced in resource-limited settings.MethodsWe retrospectively analyzed our patients with intussusception from 2009 to 2019 (11 years). Hydrostatic reduction was performed using water-soluble contrast medium (iopamidol), and reduction was followed with intermittent X-rays taken after every 50 mL of diluted contrast injection. The procedure was not continuously monitored by US or fluoroscopy. Differences in outcome based on age and gender, and yearly trends of admission for intussusception, types of treatment and mortality were analyzed.ResultsAmong 672 patients, the ratio of boys to girls was 2.46:1.0, and their ages ranged from 1 month to 15 years (median 8 months). Hydrostatic reduction was performed successfully in 351 (52.23%) patients; 308 (45.83%) patients underwent surgery; and 13 (1.93%) patients died before any intervention. There were significant differences in age between patients with successful hydrostatic reduction (median 7 months) and patients needing surgery (median 9 months) (p<0.001). The number of successful hydrostatic reductions increased during the 11 years of the study (R2=0.88). One patient (0.15%) died after hydrostatic reduction, and 10 (1.49%) died after surgery.ConclusionHydrostatic reduction with intermittent radiography was performed successfully in more than half of the patients with acceptable complication rates.

Síndrome de Boerhaave. Reporte de un caso y revisión de la literatura

The esophageal perforation is a well-documented clinical entity, with high morbidity and mortality rates. Although the etiology is usually iatrogenic, it can occur spontaneously without any known pre-existing esophageal patology. Boerhaave first described it in relation to the increased intra-abdominal pressure. Upon clinical suspicion (for the Mackler’s triad), further radiological studies (plain radiograph, chest radiograph with water-soluble contrast medium and computer tomography) are a key factors for a timely and precise diagnosis, leading to adequate treatment and managment. The objective of this study is to present a case report and a bibliographical review of the patology and its radiological signs.

Efektivitas Water Soluble Contrast Medium (Urografin®) pada Adhesive Small Bowel Obstruction (ASBO) untuk Diterapi tanpa Pembedahan di Rumah Sakit Hasan Sadikin Bandung

Pendahuluan: Adhesive small bowel obstruction (ASBO) membutuhkan penatalaksanaan yang tepat sesuai dengan algoritma diagnostik dan terapeutik yang berlaku. Indikasi dan durasi dari penatalaksanaan terapi nonoperatif serta waktu yang tepat tindakan operasi harus dilakukan masih diperdebatkan. Water soluble contrast medium (WSCM) memiliki fungsi diagnostik dan terapeutik pada pasien dengan ASBO. Metode: Jenis penelitian ini adalah before and after study dengan membandingkan dua kelompok penderita ASBO yang diterapi tanpa pembedahan yang dilakukan pemberian Urogafin dan tidak diberikan Urografin® untuk menentukan efek terapeutiknya pada pasien ASBO. Hasil: Dari karakteristik pasien ASBO ditemukan sebagian besar laki laki (55.8%) dengan rentang usia terbanyak antara 27-38 tahun. Pasien datang ke rumah sakit dengan onset ileus 2-5 hari (74.4%) dengan jenis ileus parsial sebanyak 86%(37 pasien). Interval operasi sebelumnya terbanyak < 12 bulan dengan jenis operasi terbanyak berupa appendektomi perlaparotomi. Terdapat hubungan bermakna antara pemberian WSCM dan kebutuhan terhadap relaparotomi dibandingkan dengan grup kontrol (p:0.043). Urografin® efektif dalam menurunkan Length of Stay (LOS) (p:0.01). Tidak terdapat hubungan antara pemberian WSCM terhadap angka mortalitas pasien ASBO maupun durasi ileus sebelum masuk rumah sakit dengan kebutuhan relaparotomi. Kesimpulan: Tindakan non operatif harus dipertimbangkan pada pasien ASBO tanpa tanda tanda peritonitis maupun strangulasi. Urografin® terbukti aman dan memiliki fungsi diagnosis (memprediksi tingkat resolusi adhesi dan kebutuhan operasi) dan efektif dalam fungsi terapeutik dalam menurunkan waktu resolusi obstruksi, kebutuhan akan operasi ,dan menurunkan durasi lama perawatan di rumah sakit. Posisi kontras dalam 24 jam pertama dapat dijadikan prediktor dalam memutuskan tindakan selanjutnya bagi ahli bedah.