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Perforation during attempted intussusception reduction in children--a comparison of perforation with barium and air
1Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Perforation during intussusception reduction is less severe when using air contrast compared to barium contrast. Air enema perforation leads to shorter hospital stays and reduced complications, making it the preferred method.
Area of Science:
- Pediatric Surgery
- Radiology
Background:
- Intussusception reduction is a common pediatric procedure.
- Perforation is a known complication during contrast enema reduction.
Purpose of the Study:
- To compare the clinical outcomes of perforation during intussusception reduction using barium versus air contrast.
- To evaluate the sequelae of perforation based on the contrast agent used.
Main Methods:
- Retrospective review of seven patients with barium-induced perforation and seven with air-induced perforation.
- Analysis of clinical, radiological, surgical, and pathological findings.
Main Results:
- Patients with barium enema perforation required bowel resection more often than those with air enema perforation.
- Air enema perforation was associated with shorter hospital stays and decreased morbidity.
- Perforation mechanisms included transmural necrosis, normal bowel injury, and shear injury due to increased pressure.
Conclusions:
- Perforation with air contrast is surgically manageable with better clinical outcomes compared to barium contrast.
- Despite rare risks like tension pneumoperitoneum, air contrast is preferred for its safety, speed, and efficacy in intussusception reduction.
Abstract:
This paper compares the effects on patients of perforation with barium and with air during attempted intussusception reduction by reviewing the clinical, radiological, surgical and pathological findings and sequelae in seven children who received barium and seven who received air. In both groups perforation occurred in infants under 6 months of age (with one exception) with a long duration of symptoms. All patients with barium enema required resection of bowel whereas only four with air enema required resection. Anesthetic times were longer in those patients with barium perforation in whom the intussusception did not move and there was a large leak. The patients with perforation due to air had a shorter hospital stay with decreased morbidity compared to those with perforation due to barium. Perforation occurred through areas of transmural necrosis in a minority of patients in each group. Perforations through normal bowel and shear injury (with air enema) indicate that increased pressure during the examination is an important factor in some patients. Because perforation with air is so much easier to deal with surgically and the children do better clinically, there is a tendency for some to consider perforation with air an inconsequential situation. However, a potential rare complication with this technique is tension pneumoperitoneum. Keeping this in mind, we continue to use air as the contrast of choice because the procedure in our hands is a safe, quicker and easier technique and we have achieved a substantial improvement in reduction rates. Overall reported perforation rates with air enema compare favourably with those due to barium enema.(ABSTRACT TRUNCATED AT 250 WORDS)