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Perforation during gas reduction of intussusception

K Maoate1, S W Beasley

  • 1Department of Paediatric Surgery, Christchurch Hospital, Private Bag 4710, Christchurch, New Zealand.

Pediatric Surgery International
|January 9, 1999
PubMed

Insights

Gas enema reduction for intussusception carries a 1.1% perforation risk in infants. Prompt recognition and intervention, such as paracentesis, are crucial for managing this respiratory distress complication.

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.

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