Intussusception: A repeat delayed gas enema increases the nonoperative reduction rate

Air encircling the intussusceptum on air enema for intussusception reduction: an indication for surgery?

“…There is a growing tendency to attempt repeated delayed enema intussusception reduction if a progressive partial reduction was achieved during earlier attempts, as long as the child is clinically stable and is closely observed, in order to avoid unnecessary operation [1,2,7,[10][11][12]. However, it is important to recognise which of these children will require prompt surgery, as delay may further compromise bowel viability and lead to necrosis, morbidity and sometimes even death [3,18].…”

“…Most patients with ileoileal intussusception or intussusception with a pathological lead point on sonography can also be reduced by air enema in an acute situation [7]; surgical treatment may be indicated at a later date. When complete reduction at the level of the caecum fails, repeat attempts using enema may be appropriate if the child's clinical status permits [2,[8][9][10][11][12]. If repeat attempts fail, reduction is performed surgically.…”

“…If repeat attempts fail, reduction is performed surgically. There is an ongoing quest for clinical and imaging criteria that can differentiate between patients who can benefit from repeat air enema after initial failure and those who require surgery [11][12][13]. This differentiation is important, since a delay in reduction may lead to a severe compromise of bowel viability [14].…”

Intussusception: An anatomical perspective with review of the literature

“…Greater intestinal mobility is considered a cause of intussusception and could also decrease the chance of strangulation and allow for easier reduction (Cooke and Lewis, 1960;Jona, 1986). (Clubbe, 1921) First successful surgical resection in a child Elder, 1910 Stressed early diagnosis and advised on the proper technique when performing manual surgical reduction using the gentle milking technique Hipsley, 1926 First successful hydrostatic reduction using saline Ravitch and McCune, 1948 Popularized use of barium enema as a diagnostic and therapeutic tool Bowerman et al, 1982 Introduced ultrasonography as an effective diagnostic tool for intussusceptions Guo et al, 1986 Described their successes with an air-pressure enema in 6,396 patients over a 13-year period Pracros et al, 1987 Reported 100% accuracy of sonography for the diagnosis of intussusception Saxton et al, 1994 Repeat delayed air enemas substantially increase the nonoperative reduction rate…”

“…The Chinese reintroduced air insufflation techniques, first described by Hirschsprung, for nonoperative reduction in the 1980s (Guo et al, 1986). The use of air insufflation tends to be faster, safer, cleaner, easier to perform, and also has a higher success rate than barium enemas (Guo et al, 1986;Saxton et al, 1994;Davis et al, 2003;Grosfeld, 2005). Air reduction enema has a success rate of 75-90% (Robb and Lander, 2008).…”