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Delayed Repeat Contrast Enema for Treatment of Pediatric Intussusception
Stephanie Radu1, Saunders Lin2, Louis D Le3
1School of Medicine, Oregon Health and Sciences University, Portland, Oregon.
Insights
Implementing a delayed repeat enema protocol for pediatric intussusception increased repeat enema success and reduced surgical interventions. This strategy improved outcomes for children with bowel obstruction.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Radiology
Background:
- Ileocolic intussusception is a frequent cause of bowel obstruction in children.
- Contrast enema is a primary treatment, with repeat enemas offering success in a subset of cases.
- Optimizing repeat enema protocols is crucial for improving patient outcomes.
Purpose of the Study:
- To evaluate the impact of a new protocol for delayed repeat enemas in pediatric intussusception.
- To compare intussusception recurrence, surgical rates, and length of stay between pre- and post-protocol implementation.
Main Methods:
- Retrospective review of pediatric intussusception cases at two tertiary centers.
- Comparison of outcomes before (2/2013-2/2016) and after (8/2016-11/2019) protocol implementation.
- Analysis of initial enema success, repeat enema rates, and subsequent interventions.
Main Results:
- The post-protocol group showed a higher rate of repeat enemas (66% vs 42%) and increased success with repeat enemas (52% vs 31%).
- Post-protocol patients experienced a trend toward fewer surgical interventions.
- Initial enema success rates remained similar between groups (66% vs 69%).
Conclusions:
- Protocol implementation for delayed repeat enemas significantly increased their utilization and success.
- The protocol was associated with a reduced need for operative intervention during the initial hospital stay.
- This standardized approach enhances non-operative management of pediatric intussusception.
Introduction:
Ileocolic intussusception is a common cause of pediatric bowel obstruction. Contrast enema is successful in treating the majority of patients, and if initially unsuccessful, approximately one-third may be reduced with repeat enemas. We sought to study protocol implementation for delayed repeat enema in pediatric patients not reduced completely by an initial contrast enema. Our aims were to assess repeat enema success rates and outcome differences in preprotocol and postprotocol patients with respect to (1) intussusception recurrence, (2) surgical intervention and complication rates, and (3) length of stay.
Materials And Methods:
We performed a retrospective review of treatment and clinical outcomes prior to and following protocol implementation for repeat enema for intussusception at two tertiary pediatric referral hospitals. The preprotocol period was defined from 2/2013 to 2/2016, and the postprotocol period was from 8/2016 to 11/2019.
Results:
There were 112 patients in the preprotocol group, with 74 (66%) having successful reduction following the first enema. Of the 38 patients without successful reduction, 16 (42%) patients underwent repeat enema, and five were successful (31%). The postprotocol group included 122 patients, with 84 (69%) having successful first reduction. Of the 38 patients that failed, 25 patients (66%) underwent repeat enema, of which 13 (52%) were successful. Compared to preprotocol patients, postprotocol patients had significantly more enemas repeated and a trend toward fewer surgical interventions.
Conclusions:
Protocol implementation of repeat delayed enemas was significantly associated with an increased rate of repeat enemas at our institutions and reduced need for operative intervention during the index stay.
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