The age of the patients in this study ranged from 6 months to 3 years, 60% below 1 year of age, and 90% below 2 years of age. There is statistically no significant difference in age between patients who have successful repeated reduction attempts and those who failed. This finding is in agreement with Gorenstein et al. .
Among the 40 patients of this study, there were 25 males and 15 females; the disease is commoner in males, but there is no statistical significance that age affects the results of successful repeated reduction attempts. In our study, red currant jelly stool was not a contraindication for enema reduction; it presented in 25 patients (62.5%). Twenty-one of them had a successful delayed repeated enema and 4 failed; this is not statistically significant. This finding is in agreement with Gorenstein et al. and in disagreement with McDermott et al. who wrote that rectal bleeding is more likely to cause failed delayed repeated enema [6, 7].
In our study, patients who presented with the classic triad of symptoms (pain, red currant jelly stool, and mass) were 8 patients: 5 showed successful delayed repeated enema (DRE) and 3 failed (DRE), which represents 50% of failed cases. This is statistically significant and means that patients who presented with a combined classic triad of Symptoms are more liable to surgical intervention than those without. This finding is in agreement with Simon et al. .
In our study, we used U/S as the main radiological investigation to diagnose and help in the reduction of intussusception; erect x-rays on the abdomen showed little or no information to help in the diagnosis of intussusception. This finding is in agreement with Simon et al. . In our study, we used saline enema with water-soluble contrast in a ratio of 2:1 respectively in performing DRE, under sonographic guidance, and without the use of general anesthesia. A plain erect abdominal x-ray was done in between reduction attempts in order to confirm the level of reduction and use of hygroscopic properties of the contrast to reduce edema at the ileocecal junction. Also, there is no enough evidence, but we found 2 failed cases completely reduced on laparotomy. Symptom duration before the diagnosis is a very important factor in the prediction of successful reduction. In our study, 8 patients who presented with symptoms since 6–12 h showed an 87.5% success rate, 26 patients who presented with symptoms since 12–24 h showed a 92.3% success rate, and patients who presented with symptoms more than 24 h showed 50% success rate. This is statistically significant and means that symptoms which started more than 24 h have a 50% failure rate; this finding is in agreement with Vujovic et al. . But this proves that even patients with a longer time of symptoms have a 50% success rate as long as they are vitally stable with no signs of peritonitis. In our study, we had a recurrence of 2 cases (about 5%) subjected to delayed repeated enema with no recurrence in cases subjected to surgical intervention; also, our numbers are better, but this finding is in agreement with Simon et al. . Also, in our study, there were 4 patients who have successful enema on the 4th attempt of delayed repeated enema. Also, there were 6 patients subjected to surgical intervention after 4 attempts of delayed repeated enema. Among 6 patients with surgical intervention, 2 were found completely reduced on surgical exploration. Also, 2 patients have recurrences who required no surgical intervention. This proves that there is no absolute contraindication for conservative treatment or the number of trials as long as the patient is vitally stable and shows no signs of perforation or peritonitis. This finding is in agreement with Simon et al. .
Although factors such as prolonged length of illness, rectal bleeding, altered mental status, and cases with classic triad (pain, vomiting, and bloody diarrhea) have been found to be associated with an increase rate of failed enema reduction, these factors alone are not contraindications to delayed repeat enema management.
This study was limited by the small number of cases included, and our main focus was on early non-complicated cases.