Factors associated with ultrasound-guided water enema reduction for pediatric intussusception in resource-limited setting: potential predictive role of thrombocytosis and anemia ☆ Raymond Zhun Ming Lim a, ⁎, Terance Lee a , Justin Yau Zane Ng a , Kia Fatt Quek a , Nyazirah Abdul Wahab b , Shahrul Lokman Amansah b , V Muthu Alhagi M Vellusamy c , Chin Fang Ngim a a Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Johor Bahru, Malaysia b Department of Radiology, Sultanah Aminah Hospital, Johor Bahru, Malaysia c Department of Surgery, Sultanah Aminah Hospital, Johor Bahru, Malaysia abstract article info Article history: Received 5 October 2017 Received in revised form 26 December 2017 Accepted 10 January 2018 Available online xxxx Key words: Intussusception Reduction Children Water enema Platelets Anemia Background/purpose: Although ultrasound-guided hydrostatic reduction (USGHR) is increasingly used in managing pediatric intussusception, there is limited literature concerning its use in Malaysia. We aim to examine the experience and factors associated with the effectiveness of USGHR using water. Methods: This is a single-center retrospective observational study in a Malaysian tertiary referral center. Children with intussusception admitted between year 2012 and 2016 were included and medical records reviewed. Factors associated with success or failure of USGHR were identified using multivariable logistic regression. Results: Of the 172 cases included, 151 cases (87.8%) underwent USGHR, of whom 129 cases were successfully reduced (success rate of 85.4%). One perforation (0.7%) was reported. Age more than 3 years old (aOR = 7.16; 95% CI = 1.07–47.94; p = 0.042), anemia (aOR = 10.12; 95% CI = 1.12–91.35; p = 0.039), thrombocytosis (aOR = 11.21; 95% CI = 2.06–64.33; p = 0.005) and ultrasound findings of free fluid (aOR = 9.39; 95% CI = 1.62–54.38; p = 0.012) and left-sided intussusception (aOR = 8.18;95% CI = 1.22–54.90, p = 0.031) were independently associated with USGHR irreducibility. Symptom duration, blood in stool, vomiting and other clinical presentations, however, showed no association. Conclusions: USGHR with water is effective in the non-operative management of pediatric intussusception. Prolonged symptom duration need not necessarily preclude USGHR. The findings of anemia and thrombocytosis as independent predictors of USGHR irreducibility deserve further study. Type of study: Treatment study Level of evidence: III © 2018 Elsevier Inc. All rights reserved. Intussusception is the commonest cause of acute intestinal obstruc- tion among children aged between 5 months and 3 years, with a male to female ratio of 3:1 [1]. While the mortality in most countries has sig- nificantly improved over the years, this pediatric surgical emergency still accounts for significant mortality in the developing world, with mortality rate as high as 54% [2]. In Malaysia, non-operative reduction remains the first line of treat- ment for intussusception, similar to the practice in other countries. However, the type of non-operative reduction varies in different clinical settings. While smaller hospitals still use barium enema reduction and very few centers have adopted the use of pneumatic reduction in Malaysia, USGHR is the commonest technique used in this country and it is the practice preference in many centers including ours. While the effectiveness of ultrasound-guided hydrostatic reduction (USGHR) approaches 90% in other centers [3], literature concerning the experience of non-operative reduction in Malaysia is scarce. No local study has been published concerning the management of pediatric intussusception using USGHR despite its increasing popularity. Hence, this study aims to inform practice by presenting the factors predicting the outcome of this intervention and the experience on the use of water for USGHR in a resource-limited setting. 1. Material and methods We have obtained the ethical approval from the Medical Research and Ethics Committee (MREC), Ministry of Health Malaysia and Monash Journal of Pediatric Surgery xxx (2018) xxx–xxx ☆ Funding disclosure: This research did not receive any specific grant from funding agen- cies in the public, commercial, or not-for-profit sectors. ⁎ Corresponding author at: Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Malaysia, 8, Jalan Masjid Abu Bakar, 80100, Johor Bahru, Malaysia. E-mail address: raymondlzm@gmail.com (R.Z.M. Lim). https://doi.org/10.1016/j.jpedsurg.2018.01.004 0022-3468/© 2018 Elsevier Inc. All rights reserved. Contents lists available at ScienceDirect Journal of Pediatric Surgery journal homepage: www.elsevier.com/locate/jpedsurg Please cite this article as: Lim RZM, et al, Factors associated with ultrasound-guided water enema reduction for pediatric intussusception in re- source-limited setting: potenti..., J Pediatr Surg (2018), https://doi.org/10.1016/j.jpedsurg.2018.01.004