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Mechanism of perforation occurring in the intussuscipiens during hydrostatic reduction of intussusception
Insights
Hydrostatic reduction of intussusception in infants under 6 months poses a perforation risk due to compromised blood supply, not enema pressure. This method is contraindicated in this vulnerable age group.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Radiology
Background:
- Intussusception is a common surgical emergency in infants.
- Hydrostatic reduction is a frequently used non-operative treatment.
- Bowel perforation is a rare but serious complication.
Purpose of the Study:
- To investigate the mechanism of bowel perforation during hydrostatic reduction of intussusception.
- To identify risk factors for perforation in this procedure.
Main Methods:
- Analysis of operative findings and resected specimens from children with intussusception.
- Review of cases involving bowel perforation during attempted hydrostatic reduction.
Main Results:
- Perforation typically occurs in the distal, seemingly unaffected bowel.
- Risk is highest in children under 6 months of age.
- Mechanism involves compromised blood supply to the intussusceptum leading to ischemia in the intussuscipiens, not high enema pressure.
Conclusions:
- Hydrostatic reduction is contraindicated in infants under 6 months due to inherent susceptibility to perforation.
- Understanding the ischemic mechanism is crucial for risk assessment and management.
Abstract:
Perforation of bowel during attempted hydrostatic reduction of an intussusception almost always occurs through the distal, apparently uninvolved bowel. It is probably never seen except in a group of at-risk children, under 6 months of age. It is not related to unduly high enema pressure, but to involvement of the blood supply in the intussusceptum and obstruction of the blood supply with resulting ischemic changes in the "apparently" uninvolved intussuscipiens. The authors provide support for their suggested mechanism by their findings at operation and in the resected specimens from seven children with an irreducible intussusception and one 5-month-old child whose bowel perforated during attempted hydrostatic reduction. Because children under 6 months of age are susceptible to perforation, hydrostatic reduction of intussuscepted bowel is contraindicated.