Perforation during gas reduction of intussusception

Area of Science:

• Pediatric Gastroenterology
• Abdominal Imaging
• Surgical Complications

Background:

• Intussusception is a common pediatric surgical emergency.
• Gas enema reduction is a frequently used therapeutic modality.
• Perforation is a known but infrequent complication of gas enema reduction.

Purpose of the Study:

• To determine the incidence of perforation during gas enema reduction of intussusception.
• To identify risk factors and clinical features associated with perforation.
• To describe the management and outcomes of perforation during gas enema reduction.

Main Methods:

• Retrospective review of 650 consecutive attempted gas enemas for intussusception.
• Analysis of clinical data, radiologic findings, and procedural outcomes.
• Case series review of 7 children who sustained perforation during gas enema.

Main Results:

• Perforation occurred in 7 infants (1.1%) during gas enema reduction.
• Pneumoperitoneum led to rapid abdominal distension and acute respiratory distress in affected infants.
• All perforated cases showed prior radiologic evidence of bowel obstruction and a longer symptom history.
• No perforations occurred during delayed repeat enema reductions.
• Perforation resulted in minimal peritoneal contamination, with no identified pathological lead point.

Conclusions:

• Gas enema reduction for intussusception has a low but significant risk of perforation.
• Early recognition of pneumoperitoneum and prompt intervention are vital for managing respiratory distress.
• Patients with pre-existing bowel obstruction and prolonged symptoms may be at higher risk.
• Delayed repeat enemas appear safe, and perforations cause minimal contamination.