If the first attempt at nonoperative reduction of intussusception fails, when should repeated attempts be made?

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

The value of repeated attempts at nonoperative reduction, if the first attempt is unsuccessful, has not been determined. Some clinicians recommend taking the patient to surgical care if the first attempt fails, and other clinicians advocate 1 or 2 subsequent attempts within a few minutes to a few hours after the first attempt. [27] Delay between the reduction attempts may place the patient in the "window" of spontaneous resolution, which has been reported with an incidence of 5-6%. In addition, the first attempt can reduce the intussusception partially, making the intussusceptum less edematous, with improved venous drainage.

Some reports have postulated that reduced bowel edema with improved venous drainage is one of the reasons why the success rate of hydrostatic reduction increases with the administration of a second enema. If repeated attempts are unsuccessful, any progress in pushing back the intussusceptum toward the ileocecal valve during operative reduction is advantageous. Delay in performing surgery because of additional attempts at nonoperative reduction has been demonstrated to have no adverse effects on the rates of success of operative reduction and patient morbidity.


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