What is the role of nonoperative reduction in the treatment of intussusception?

Updated: Dec 20, 2018
  • Author: A Alfred Chahine, MD; Chief Editor: Carmen Cuffari, MD  more...
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Answer

Tailor treatment of the child with intussusception to the stage at presentation. For all children, start intravenous fluid resuscitation and nasogastric decompression as soon as possible.

The presence of peritonitis and any evidence of perforation revealed on plain radiographs are the only 2 absolute contraindications to an attempt at nonoperative reduction with a therapeutic enema. Therapeutic enemas can be hydrostatic, with either barium or water-soluble contrast, or pneumatic, with air insufflation. Therapeutic enemas can be performed under fluoroscopic or ultrasonographic guidance. The technique chosen is not important as long as the radiologist performing the enema is comfortable with the method. Preferably, the pediatric surgeon involved is present at the reduction.

A study by Flaum et al presented their experience in intussusception reductions using saline enema under ultrasound control and concluded that it is an efficient and safe procedure. [26]

Since Harald Hirschsprung’s description of a systematic approach to hydrostatic reduction of intussusception, the reported success rate of this nonoperative intervention has widely varied (< 40% to >90%). This variability in outcome attests to the various factors involved in successful hydrostatic reduction. Among these are factors that are individual to the patient (age, duration of symptoms, presence of lead points) and others that depend on the technique used. Paramount among the latter category is the availability of a team of pediatric surgeons and radiologists with the necessary expertise, determination, and dedication. Even among pediatric radiologists, consensus has been lacking on methodologic issues, including the choice of reducing agent, the type of catheter, the role of the external manipulation of the abdomen, the use of medications, and the establishment of guidelines for pressure limits and number of attempts.


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