Factors associated with failure of hydrostatic reduction in children with ileocolic intussusception

BACKGROUND/OBJECTIVES: There remains controversy regarding the risk factors for failed hydrostatic enema reduction; therefore, we aimed to identify additional factors associated with unsuccessful hydrostatic enema reduction in children with ileocolic intussusception. METHODS: This study was conducted retrospectively in two tertiary centers. Data were collected from patient charts or electronic medical records and consisted of pediatric intussusception cases treated with hydrostatic reduction during January 2021 and January 2025. Univariate and multivariate analyses, incorporating stepwise logistic regression, were conducted. RESULTS: Two hundred thirty-one patients with ileocolic-type intussusception were included and treated by ultrasound-guided hydrostatic reduction at two different institutions. Hydrostatic reduction was successful in 199 patients (86.2%), failed in 32 (13.8%). All patients were successfully discharged with uneventful recoveries. On multivariate analysis, under 12-month-old(OR = 58.106,P < 0.001 95%CI,14.166-238.338),an Onset of symptoms>48 h (OR = 7.070,P = 0.014 95%CI,1.491-33.517), previous history of intussusception (OR = 42.721, P < 0.001 95%CI,5.729-318.572), constipation (OR = 31.488, P < 0.001 95%CI,5.597-177.137), and bowel Wall Thickening on US(OR = 8.177, P = 0.015 95%CI,1.513-43.553) were significantly associated with failed hydrostatic enema reduction. CONCLUSIONS: An age of under 1 year, previous history of intussusception, onset of symptoms, constipation, and bowel wall thickening on US were risk factors for failed hydrostatic reduction of ileocolic intussusception. Older children with long-term recurrent intussusception are at high risk of pathological leading points(PLPs) and hydrostatic reduction failure, requiring close pediatric surgical attention. Patients with these findings warrant early surgical consultation or transfer to a facility with pediatric surgical capabilities.