What question did this study set out to answer?

To identify predictors of ultrasound-guided hydrostatic saline enema reduction failure and pathological lead points in pediatric intussusception.

February 19, 2026Pediatric Surgery International1 citationsOpen Access

Determinants of ultrasound-guided reduction failure and pathological lead points in pediatric intussusception

YBYannick BraunGoethe University Frankfurt HFHenning C. FiegelGoethe University Frankfurt URUdo Ure RolleGoethe University Frankfurt

Key Points

To identify predictors of ultrasound-guided hydrostatic saline enema reduction failure and pathological lead points in pediatric intussusception.
Retrospective review of pediatric patients under 18 with ileocolic intussusception from 2012 to 2022.
Analysis of clinical variables like symptom duration, vomiting, bloody stools, and age.
Utilization of univariable and multivariable logistic regression analyses to identify predictors.
Overall reduction success was 76.92% in the sample.
Symptom duration greater than 24 hours was associated with a significant increase in reduction failure (OR 4.29).
Bloody stools and younger age were also identified as predictors of reduction failure.
Approximately 20.2% of cases had pathological lead points, mainly Meckel's diverticulum.
Failed reduction was a strong independent predictor of underlying pathological lead points (OR 107.26).

Abstract

Abstract Purpose Intussusception is a leading cause of acute intestinal obstruction in children. Ultrasound-guided hydrostatic saline enema (USGSE) is widely accepted as first-line non-surgical management, but predictors of reduction failure and pathological lead points (PLPs) are not well defined. Methods We retrospectively reviewed pediatric patients ( 24 h was associated with failed USGSE (OR 4.29, p = 0.0052). After excluding PLP cases, predictors of failure included symptom duration > 24 h (OR 13.97, p = 0.0059), bloody stools (OR 6.83, p = 0.0245), and younger age ( p = 0.0094). PLPs were identified in 18 patients (20.2%), most commonly Meckel’s diverticulum. Failed USGSE was the sole independent predictor of a PLP (OR 107.26, p < 0.0001). Conclusion USGSE is safe and highly effective for pediatric ileocolic intussusception. Prolonged symptoms and bloody stools predict reduction failure, while failed USGSE strongly indicates an underlying PLP, supporting prompt intervention and surgical evaluation when reduction is unsuccessful.

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