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Partially reduced intussusception: when are repeated delayed reduction attempts appropriate?
B Connolly1, D J Alton, S H Ein
1Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
In infants with partially reduced intussusception, delaying surgery for repeat air enema reduction is safe if the child is stable. Ultrasound confirms intussusception persistence, guiding further treatment to avoid surgery.
Area of Science:
- Pediatric Surgery
- Diagnostic Imaging
Background:
- Intussusception reduction aims to avoid surgical morbidity.
- Fluoroscopy and ultrasound techniques are evolving for diagnosis and monitoring.
Observation:
- Two infants with partial intussusception reduction after initial air enema.
- Patients remained asymptomatic and clinically stable post-initial attempt.
Findings:
- Deferred laparotomy allowed for repeat air enema attempts.
- Sonography confirmed persistent intussusception before subsequent enemas.
- Successful reduction achieved after multiple enemas over 20-24 hours, avoiding surgery.
Implications:
- Suggests delaying surgery in stable infants with partial intussusception allows for further enema reduction attempts.
- Highlights the role of sonography in guiding repeat enemas.
- Emphasizes the need for close surgical collaboration and clinical monitoring.
Abstract:
The imaging techniques for diagnosis and monitoring of reduction of intussusception by fluoroscopy and ultrasound continue to evolve. The common goal of all protocols is to reduce the intussusception by enema in as many patients as possible and avoid laparotomy with its potential morbidity. We report two infants in whom the initial attempt at reduction by air enema only achieved partial reduction, from the descending colon to the transverse colon in one, and from the splenic flexure to the caecum in the other. Both patients became asymptomatic and clinically stable. In light of the clinical stability, and in consultation with the surgeons, laparotomy was deferred. Sonography was used to confirm the persistence of the intussusception before repeat air enema several hours later. Following three further air enemas in each child, the intussusceptions were successfully reduced after 20 h and 24 h respectively. Both patients remained asymptomatic and did not require surgery. In infants with partially reduced intussusception we suggest that if the patient becomes asymptomatic and stable, surgery can be safely delayed to permit further attempts at enema reduction. Sonography has a valuable role in determining the persistence of the intussusception prior to repeat enema. Close cooperation with the surgeon and careful clinical monitoring of the patient are essential requirements for this proposal.