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Delayed Repeated Enema and Operative Findings after Unsuccessful Primary Enema for Intussusception
28 December 2011
21 April 2012
07 July 2012 (online)
Introduction The purpose of this study was (1) to evaluate the role for and the potential morbidity associated with delayed repeated enema (DRE) and (2) to compare surgical findings for patients undergoing operative exploration after failed primary enema and DRE reduction attempts for intussusception.
Methods After obtaining approval from the Internal Review Board, we completed a retrospective review of all patients treated for intussusception at a large, tertiary care pediatric hospital. We evaluated the success of primary reduction enema, DRE, and compared surgical findings after failed enema reduction.
Results A total of 135 intussusceptions underwent an attempt at enema reduction following diagnosis. Of these, 83 (61.5%) intussusceptions were reduced with primary enema. Thirty-four patients (25.2%) proceeded directly to surgical exploration after a failed primary enema and 4 more patients were explored after successful reduction due to suspicion for a pathologic lead point. Thirty-four of these operations were therapeutic. In this, four patients had a negative exploration; eight patients required a bowel resection due to necrotic bowel, perforation, or persistence of an irreducible intussusception. Eighteen patients underwent a DRE after a failed primary enema. Two DREs revealed the intussusception had completely reduced before the study, and 11 DREs were successful in reducing persistent intussusceptions. Five patients underwent operative exploration after a failed DRE and were all found to have a persistent intussusception which was successfully reduced intraoperatively. There were no negative laparotomies, pathologic lead points, or instances of necrotic bowel or perforation in patients explored following unsuccessful DRE and no bowel resections were required.
Conclusions The use of DRE in select patients with persistence of an intussusception may result in successful subsequent reduction with no apparent increase in morbidity. A DRE may lead to improved outcomes for patients with intussusception through avoidance of unnecessary surgical reductions and negative explorations.
- 1 Beasley SW, Myers NA. Intussusception: current views. Pediatr Surg Int 1998; 14 (3) 157
- 2 Gorenstein A, Raucher A, Serour F, Witzling M, Katz R. Intussusception in children: reduction with repeated, delayed air enema. Radiology 1998; 206 (3) 721-724
- 3 Navarro OM, Daneman ARE. RE: intussusception due to pathologic lead points. Australas Radiol 2005; 49 (1) 88
- 4 Sandler AD, Ein SH, Connolly B, Daneman A, Filler RM. Unsuccessful air-enema reduction of intussusception: is a second attempt worthwhile?. Pediatr Surg Int 1999; 15 (3-4) 214-216
- 5 Saxton V, Katz M, Phelan E, Beasley SW. Intussusception: a repeat delayed gas enema increases the nonoperative reduction rate. J Pediatr Surg 1994; 29 (5) 588-589
- 6 Navarro OM, Daneman A, Chae A. Intussusception: the use of delayed, repeated reduction attempts and the management of intussusceptions due to pathologic lead points in pediatric patients. AJR Am J Roentgenol 2004; 182 (5) 1169-1176
- 7 Gu L, Alton DJ, Daneman A , et al. John Caffey award. Intussusception reduction in children by rectal insufflation of air. AJR Am J Roentgenol 1988; 150 (6) 1345-1348
- 8 Guo JZ, Ma XY, Zhou QH. Results of air pressure enema reduction of intussusception: 6,396 cases in 13 years. J Pediatr Surg 1986; 21 (12) 1201-1203
- 9 Maoate K, Beasley SW. Perforation during gas reduction of intussusception. Pediatr Surg Int 1998; 14 (3) 168-170
- 10 McDermott VG, Taylor T, Wyatt JP, MacKenzie S, Hendry GM. Orogastric magnet removal of ingested disc batteries. J Pediatr Surg 1995; 30 (1) 29-32
- 11 Stein JE, Beasley SW, Phelan E. The cost benefit of changing protocols in the management of intussusception. Aust N Z J Surg 1997; 67 (6) 330-331
- 12 Zheng JY, Frush DP, Guo JZ. Review of pneumatic reduction of intussusception: evolution not revolution. J Pediatr Surg 1994; 29 (1) 93-97
- 13 Franken Jr EA, Smith WL, Chernish SM, Campbell JB, Fletcher BD, Goldman HS. The use of glucagon in hydrostatic reduction of intussusception: a double-blind study of 30 patients. Radiology 1983; 146 (3) 687-689
- 14 Hadidi AT, El Shal N. Childhood intussusception: a comparative study of nonsurgical management. J Pediatr Surg 1999; 34 (2) 304-307
- 15 Kirks DR. Air intussusception reduction: “the winds of change”. Pediatr Radiol 1995; 25 (2) 89-91
- 16 Mortensson W, Eklöf O, Laurin S. Hydrostatic reduction of childhood intussusception. The role of adjuvant glucagon medication. Acta Radiol Diagn (Stockh) 1984; 25 (4) 261-264
- 17 Katz M, Phelan E, Carlin JB, Beasley SW. Gas enema for the reduction of intussusception: relationship between clinical signs and symptoms and outcome. AJR Am J Roentgenol 1993; 160 (2) 363-366
- 18 Reijnen JA, Festen C, van Roosmalen RP. Intussusception: factors related to treatment. Arch Dis Child 1990; 65 (8) 871-873
- 19 van den Ende ED, Allema JH, Hazebroek FW, Breslau PJ. Success with hydrostatic reduction of intussusception in relation to duration of symptoms. Arch Dis Child 2005; 90 (10) 1071-1072