Are we doing better? Barium enema reduction of intussusception

Introduction Intussuception remains one of the most common surgical abdominal emergencies in the paediatric population. The aim of this study was first to re-evaluate our non-operative reduction rate of intussusception using multiple interval barium enemas and second to investigate or discuss an audit cycle, providing evidence and validating the modification of clinical practice. Materials and methods This five-year retrospective study performed at one of two institutions at which a paediatric surgical service is offered. Individuals included were all patients under 12-years of age who were diagnosed with intussusception. Factors considered to be influential in the reduction of the intussusception were collected. End points were defined as successful barium enema reduction or surgical intervention. Results were compared with similar research published in 2010. Results Overall prevalence was found to be 12 cases/year, with a sample size of 60 patients, the mean age at presentation of 13.6 months. Barium enema reduction was attempted in 56/60 patients, while 4/60 patients had operative management as a first intervention. Overall reduction rate was 66% (37/56), 78% occurring on first attempt and 22% on the second attempt. There was no evidence of intussusception in 3/19 patients who had operative management as a second intervention. Delayed interval barium enema reduction demonstrated an improved reduction rate of 66% compared with single-use barium enema reduction of 41% (chi square 0.02). Conclusion A significant benefit was achieved by performing delayed interval enema reduction, which contributed to a 61% increased reduction rate, the actual reduction rate approaches 71%. The audit cycle remains of paramount importance to ensure optimum patient care.