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Intussusception: toward less surgery?

S H Ein¹, S B Palder, D J Alton

¹Division of General Surgery, Hospital for Sick Children, Toronto, Ontario.

Journal of Pediatric Surgery

|March 1, 1994

Summary

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Ileocolic intussusception can be successfully reduced using air enema, even without terminal ileum filling. This finding challenges traditional criteria for surgical intervention in pediatric cases.

Area of Science:

Pediatric Radiology
Gastroenterology
Surgical Pediatrics

Background:

Ileocolic intussusception is commonly treated with hydrostatic reduction using barium under fluoroscopic guidance.
A historical criterion for successful reduction included adequate reflux into the distal ileum, with failure necessitating surgery.
Spontaneous reduction occurs in approximately 10% of cases, highlighting potential for nonoperative management.

Purpose of the Study:

To evaluate the efficacy of air enema reduction for ileocolic intussusception, particularly in cases lacking terminal ileum filling.
To assess outcomes for pediatric patients treated with air enema reduction without meeting traditional criteria for complete reduction.

Main Methods:

A retrospective review of 503 air contrast colon studies for suspected intussusception in children aged 2 days to 13 years (October 1985–March 1991).

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Analysis of reduction success rates and clinical outcomes, focusing on cases where terminal ileum filling was absent post-reduction.

Main Results:

Of 241 identified intussusceptions, 196 (81%) were reduced. 45 cases proceeded to surgery.
Three pediatric patients (4 months–2 years) experienced successful air enema reduction without terminal ileum filling and remained asymptomatic initially.
These three patients were observed nonoperatively; two experienced recurrent pain but repeat air enemas were normal.

Conclusions:

Air enema reduction of ileocolic intussusception can be successful even without observed terminal ileum filling.
The absence of terminal ileum filling should not automatically mandate surgical intervention.
Nonoperative management and observation may be appropriate in select cases of successful air enema reduction.