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International Expert Consensus and Recommendations for Neonatal Pneumothorax Ultrasound Diagnosis and Ultrasound-guided Thoracentesis Procedure
Published on: March 12, 2020
Needle decompression to avoid tension pneumoperitoneum and hemodynamic compromise after pneumatic reduction of
Sara C Fallon1, Eugene S Kim, Bindi J Naik-Mathuria
1Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
Insights
Tense pneumoperitoneum is a rare but life-threatening complication of pneumatic reduction for intussusception in children. Immediate intervention and surgical management are crucial for these serious cases.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Radiology
Background:
- Ileocolic intussusception management often involves pneumatic reduction.
- Complications include perforation and tension pneumoperitoneum, necessitating surgical intervention.
- Four cases of perforation with tension pneumoperitoneum during pneumatic reduction occurred recently.
Observation:
- A review of 101 children with intussusception in 2011 was conducted.
- Four children (4%) developed tension pneumoperitoneum during air enema reduction.
- These patients required urgent needle decompression and subsequent bowel resection.
Findings:
- Tension pneumoperitoneum is a serious, life-threatening complication of pneumatic enemas.
- Immediate intervention and surgical management are required.
- No deaths were reported in the studied cases.
Implications:
- Practitioners should exercise caution with pneumatic reduction, especially in centers with limited pediatric radiology or surgical support.
- Prompt recognition and management are vital for patient outcomes.
- This complication highlights the importance of experienced personnel and available resources.
Background:
The contemporary management of children with ileocolic intussusception often includes pneumatic reduction. While failure of the procedure or recurrence after reduction can result in the need for surgical treatment, more serious adverse sequelae can occur including perforation and, rarely, tension pneumoperitoneum. During the last year, four cases of perforation during attempted pneumatic reductions complicated by tense pneumoperitoneum have occurred in our center.
Objective:
We have elected to report our patient experience, describe methods of management and review available literature on this uncommon but serious complication.
Materials And Methods:
Using ICD-9 diagnosis codes, we reviewed the records of children with intussusception during 2011. Demographic and therapeutic clinical data were collected and summarized.
Results:
During the study period, 101 children with intussusception were treated at our institution, with 19% (19/101) of them requiring surgical intervention. Four children (4%) experienced a tense pneumoperitoneum during air enema reduction, prompting urgent needle decompression in the fluoroscopy suite. These children required bowel resection during subsequent laparotomy. No deaths occurred.
Conclusion:
Pneumoperitoneum is a real and life-threatening complication of pneumatic enemas. It requires immediate intervention and definitive surgical management. Caution should be exercised by practitioners performing this procedure at institutions where pediatric radiology experience is limited and immediate pediatric surgical support is not available.
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