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Hydrostatic reduction of ileocolic intussusception: a second attempt in the operating room with general anesthesia
D L Collins1, L E Pinckney, K E Miller
1Department of Surgery, Children's Hospital and Health Center, San Diego, CA 92123.
Insights
A second contrast enema under general anesthesia successfully reduced ileocolic intussusception in 68% of children who failed initial nonoperative treatment. This improved the overall nonoperative reduction rate, avoiding surgery.
Area of Science:
- Pediatric Surgery
- Gastroenterology
Background:
- Ileocolic intussusception is a common pediatric surgical emergency.
- Standard hydrostatic pressure reduction via contrast enema has limitations and failure rates.
Purpose of the Study:
- To evaluate the efficacy of a second contrast enema under general anesthesia for pediatric ileocolic intussusception.
- To determine if this approach improves nonoperative reduction rates and avoids surgery.
Main Methods:
- A retrospective review of children with ileocolic intussusception over a 3-year period.
- Children who failed initial nonoperative reduction received a second contrast enema under general anesthesia prior to potential laparotomy.
Main Results:
- The second contrast enema successfully reduced intussusception in 21 of 31 (68%) children.
- The overall nonoperative reduction rate increased to 84% (90% in the last 2 years).
- This approach avoided surgery in a significant proportion of cases.
Conclusions:
- A second contrast enema administered under general anesthesia is a safe and effective method to increase nonoperative reduction rates for ileocolic intussusception.
- This strategy can help avoid the complications, hospitalization, and costs associated with surgical intervention.
Abstract:
Over a 3-year-period, standard treatment with hydrostatic pressure from a contrast enema failed to reduce ileocolic intussusception in 31 of 62 children. With the child anesthetized in the operating room, a second contrast enema was given before laparotomy. Of the 31 intussusceptions, 21 (68%) were reduced without complication, thereby avoiding the discomfort, longer hospitalization, complications, and expense of surgery. Nine of the remaining 10 intussusceptions were difficult to reduce manually during surgery or required resection. The overall nonoperative reduction rate for the 3-year period was 84%; for the last 2 years it was 90%. Success with the second enema may be related to the effects of general anesthesia. In addition, partial reduction with the first enema may improve blood flow from the intussusceptum so that it becomes smaller and easier to reduce with the second enema. Because it can easily be added to standard management protocols without increased risk, routine use of this second enema with anesthesia is recommended.