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Intussusception: barium or air?
S B Palder1, S H Ein, D A Stringer
1Division of General Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Air enema is the preferred method for reducing intussusception, showing similar success rates to barium enema but with fewer complications. This study supports air enema as the initial treatment of choice for intussusception.
Area of Science:
- Pediatric Radiology
- Gastroenterology
Background:
- Intussusception is a common surgical emergency in infants and children.
- Traditionally, barium enema was used for reduction, but air enema has emerged as an alternative.
Purpose of the Study:
- To compare the efficacy and safety of air enema versus barium enema for intussusception reduction.
- To evaluate factors associated with successful reduction and complications.
Main Methods:
- Retrospective review of 200 consecutive intussusception cases.
- 100 patients treated with barium enema and 100 with air enema.
- Comparison of success rates, complications, and recurrence between the two methods.
Main Results:
- Successful reduction rates were similar: 75% for barium enema and 76% for air enema.
- Complications included perforations (3 with barium, 2 with air) and recurrence (18 with barium, 9 with air).
- Failure was associated with lead points or ileoileal/ileoileocolic intussusceptions.
Conclusions:
- Air enema is a safe and effective alternative to barium enema for intussusception reduction.
- Air enema offers advantages due to lower X-ray absorption and inert nature.
- Air enema is recommended as the treatment of choice for initial management of intussusception.
Abstract:
At The Hospital For Sick Children, the use of air has recently replaced the use of barium in the reduction of intussusceptions. The purpose of this study was to review the results from 200 consecutive patients with intussusceptions, 100 patients treated with barium enema and 100 patients treated with air enema. The groups were similar with regard to sex, average and median ages, and presenting symptoms and signs. Successful reduction was achieved in 75% of episodes of intussusception treated with barium enema and 76% treated with air enema. Failure of either modality showed a high association with the presence of either a lead point or an ileoileal or ileoileocolic intussusception. Among those cases of unsuccessful reduction, operation was performed in all 59 cases; resection in 30 cases, manual reduction in 19, and spontaneous reduction was found in 10. There were three perforations during attempted reduction with barium and two with air. All perforations were treated by resection and primary anastomosis. There were 18 recurrent intussusceptions following barium enema reduction and nine following air enema reduction. Therefore, with the lower absorption of x-rays by air and the relatively inert nature of air (compared with barium in the event of a perforation), we feel that air enema is the treatment of choice in the initial management of intussusception.