Hydrostatic reduction of ileocolic intussusception: a second attempt in the operating room with general anesthesia.
Over a 3-year-period, standard treatment with hydrostatic pressure from a contrast enema failed to reduce ileocolic intussusception in 31 of 62 children. With the child anesthetized in the operating room, a second contrast enema was given before laparotomy. Of the 31 intussusceptions, 21 (68%) were reduced without complication, thereby avoiding the discomfort, longer hospitalization, complications, and expense of surgery. Nine of the remaining 10 intussusceptions were difficult to reduce manually during surgery or required resection. The overall nonoperative reduction rate for the 3-year period was 84%; for the last 2 years it was 90%. Success with the second enema may be related to the effects of general anesthesia. In addition, partial reduction with the first enema may improve blood flow from the intussusceptum so that it becomes smaller and easier to reduce with the second enema. Because it can easily be added to standard management protocols without increased risk, routine use of this second enema with anesthesia is recommended.
Department of Surgery, Children's Hospital and Health Center, San Diego, CA 92123.
D L
DL
Collins
L E
LE
Pinckney
K E
KE
Miller
J F
JF
Bastian
D O
DO
Katzman
T G
TG
Canty
J
J
Waldman
D000768:Anesthesia, General; D002648:Child; D002675:Child, Preschool; D004733:Enema / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D006874:Hydrostatic Pressure; D007077:Ileal Diseases / Q000628:therapy*; D007223:Infant; D007443:Intussusception / Q000628:therapy*; D008297:Male; D009873:Operating Rooms