Child Health/Paediatric surgery

Intussusception reduction (air enema)

also: air enema · intussusception · reduction

Overview

Radiological air-enema reduction is first-line for intussusception; surgery is reserved for failure or complications.

Mechanism

An air (or contrast) enema hydrostatically/pneumatically pushes the telescoped bowel back — successful in ~75%. Surgery (reduction ± resection) is needed if the enema fails, or there is peritonitis, perforation or non-viable bowel.

Indications

Intussusception WITHOUT peritonitis, perforation or shock

The agents

Air enemafirst-line

~75% success

After fluid resuscitation; recurrence ~10%.

Surgical reduction ± resectionif enema fails/perforation

Resect non-viable bowel.

Adverse effects

Perforation during enemaserious

Recurrence (~10%)common

Bowel resection if non-viableserious

Cautions & contraindications

Air enema if peritonitis / perforation / shockpaediatric

Go straight to surgery.

Choosing it

Infant 6 months–2 years with intermittent colicky pain (drawing knees up), vomiting, a "redcurrant-jelly" stool and a sausage-shaped abdominal mass; ultrasound shows a target/donut sign.

Source: OHCS — Intussusception