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

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 (< 18 years) with ileocolic intussusception treated between 2012 and 2022. Clinical variables included symptom duration, vomiting, bloody stools, and age. Univariable and multivariable logistic regression analyses were used to identify predictors of failed USGSE and PLPs. RESULTS: Eighty-nine patients (93 episodes) were analyzed; 97.85% underwent USGSE as initial treatment. Overall reduction success was 76.92% (70/91) and 90.28% (65/72) in patients without PLPs, with no complications. Symptom duration > 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.