Role of surgery in the era of highly successful air enema reduction of intussusception.
BACKGROUND
Despite routine use of air enema reduction in childhood intussusceptions, some still require operative management. This study evaluated the role of surgery and identified factors associated with failed air enema reduction and bowel resection.


METHODS
We reviewed 24 patients who underwent laparotomies for intussusception between 1 July 1999 and 31 July 2002. Demographic data, clinical presentations, investigations, surgical interventions and their outcomes were reviewed.


RESULTS
Twenty-four (14.5%) of 166 patients treated for intussusceptions between 1 July 1999 and 31 July 2002 underwent laparotomies. A significant proportion (45.8%) was younger than 3 months and older than 36 months of age. Intussusception was diagnosed on ultrasonography in 21 patients. Eighteen underwent attempted air enema reduction. Ileocolic intussusceptions occurred in 54.2% of patients. Five patients had small bowel intussusceptions, all of whom required bowel resection. Seven patients (29.2%) had pathological lead points. Presence of pathological lead points and intussusceptions occurring outside the ileocolic region strongly predicted the need for bowel resection.


CONCLUSIONS
Air enema reductions are less likely to succeed in patients less than 3 months old and those more than 3 years old. Bowel resection is most likely required when pathological lead points are present and when intussusceptions occur outside the ileocolic region. Early surgical intervention may obviate the need for bowel resection in selected patients, thereby reducing surgical morbidity.
Chua
Joyce H Y
JH
Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore. joyce.chua.h.y@singhealth.com.sg
Chui
Chan Hon
CH
Jacobsen
Anette S
AS
D000367:Age Factors; D000388:Air; D002648:Child; D002675:Child, Preschool; D004378:Duodenal Diseases / Q000175:diagnosis / Q000601:surgery* / Q000628:therapy; D004733:Enema; D005260:Female; D006801:Humans; D007077:Ileal Diseases / Q000175:diagnosis / Q000601:surgery* / Q000628:therapy; D007223:Infant; D007443:Intussusception / Q000175:diagnosis / Q000601:surgery* / Q000628:therapy; D007813:Laparotomy; D008297:Male; D013997:Time Factors