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Contrast media in intussusception
1Department of Radiology, Children's Hospital, Denver, Colorado.
Insights
Pediatric radiologists predominantly use barium for intussusception diagnosis and treatment. Barium enemas are common even with suspected small bowel obstruction, showing a low perforation rate.
Area of Science:
- Radiology
- Pediatric Imaging
- Gastrointestinal Diagnostics
Background:
- Intussusception is a common pediatric surgical emergency.
- Contrast enema is a primary diagnostic and therapeutic tool for intussusception.
- Choice of contrast media and associated risks require ongoing evaluation.
Purpose of the Study:
- To survey North American pediatric radiologists regarding contrast media selection for intussusception.
- To assess current practices in contrast enema administration for intussusception, including cases with suspected small bowel obstruction.
- To determine the incidence and outcomes of complications, specifically perforation, associated with barium enemas.
Main Methods:
- A survey was conducted among pediatric radiologists across 40 children's hospitals in North America.
- Respondents were interviewed about their preferred contrast agents for intussusception diagnosis and treatment.
- Data on intussusception cases, including the use of barium enema and occurrences of perforation, were analyzed.
Main Results:
- Barium was the overwhelmingly preferred contrast medium for intussusception management.
- Most radiologists would perform a barium enema even with clear evidence of small bowel obstruction on plain films.
- Out of over 14,000 intussusception cases, 55 perforations occurred (approximately 1 in 250), with most being well-tolerated, but one fatality was reported.
Conclusions:
- Barium remains the standard contrast agent for pediatric intussusception.
- The practice of performing barium enemas despite evidence of small bowel obstruction is prevalent.
- While perforations are infrequent and generally well-tolerated, they represent a significant risk that warrants careful consideration.
Abstract:
Pediatric radiologists in 40 children's hospitals in North America were interviewed to determine their choice of contrast media in the diagnosis and treatment of intussusception. The respondents indicated that barium was utilized in the vast majority of instances. Almost all indicated that they would proceed with barium enema even if there is unequivocal evidence of small bowel obstruction on the plain film examination. In over 14,000 cases of intussusception, there were 55 perforations, an incidence of approximately 1 in 250. The perforations in general were well tolerated, although there was one death.