Perforation of the intussuscepted colon

Hospital records were reviewed of almost 1,000 infants and children with intussusception during a 25 year period. Among the approximately 850 who had barium enemas, six had colonic perforations during the attempted hydrostatic barium enema reduction of the intussusception. All occurred in patients 6 months old or less. Most had preceding viral illness, four had pain, all vomited, five had rectal bleeding, and only one had a palpable mass. All were pale, dehydrated, lethargic, and had intermittent mottling of the skin and complete bowel obstruction. All had been ill for over 36 hr. The perforations occurred through areas of necrotic ischemic colon. All infants required a right hemicolectomy. These babies seem to fit a pattern in which they are younger and sicker longer than the average patient with intussusception and have complete bowel obstruction. These facts are a warning that such infants are at increased risk for a barium enema bowel perforation.