Non-Operative Reduction of Childhood Intussusception in Low- and Middle-Income Countries: A Review of Techniques, Outcomes, and Emerging Challenges.

Intussusception is a leading cause of intestinal obstruction in infants and young children. Non-operative reduction techniques, particularly saline hydrostatic and pneumatic methods, have significantly reduced the need for surgery. This review highlights the techniques, outcomes, and challenges associated with non-operative management of childhood intussusception in low-and middle-income countries (LMICs). A structured narrative review of the literature was conducted using PubMed, Google Scholar, AJOL, Cochrane Library, and WHO databases, focusing on studies cited in the comparative analysis of saline hydrostatic and pneumatic reduction techniques. Both prospective and retrospective studies on paediatric intussusception reporting outcomes of non-operative management were included. Articles emphasizing surgical-only approaches were excluded. Saline hydrostatic reduction under ultrasound guidance shows success rates of 60 to 90% with the advantage of being radiation-free and relatively more feasible in resource-limited settings. Pneumatic reduction has success rates of 70 to 95%, shorter procedure times, and lower complication rates, but it is constrained by the need for fluoroscopic equipment (in most settings) and trained personnel. Delayed presentation, poor health-seeking behavior, inadequate imaging facilities and shortage of trained providers remain major barriers in LMICs, contributing to morbidity and mortality. Both saline hydrostatic and pneumatic reduction are effective for non-operative management of intussusception. To improve outcomes in LMICs, there is a need for increased investment in imaging capacity, training of healthcare workers, public awareness campaigns and adoption of innovative low-cost models.