title: Air encircling the intussusceptum on air enema for intussusception reduction: an indication for surgery?
abstract: OBJECTIVE
  The prompt identification of children in whom enema reduction of intussusception might fail and surgery is necessary is crucial in order to avoid futile repeat attempts and untoward complications. The purpose of this retrospective review was to determine whether air encircling the intussusceptum in the small bowel during air enema for intussusception reduction could serve as an indication for operation rather than repeat attempts at radiological reduction.
  
  
  METHODS
  Imaging studies of 83 children aged 4 to 40 months with idiopathic intussusception who had air enema for intussusception reduction were reviewed for the presence of air encircling the intussusceptum in the distal small bowel. Findings were correlated with clinical course and surgical findings.
  
  
  RESULTS
  In 12 of 83 patients, air was seen encircling the intussusceptum in the small bowel, and in 11 of these (88%) air enema failed to reduce the intussusception. In 8 of the 11, delayed repeated attempts using air enema failed to reduce intussusception. Clinical signs and their duration did not differ between those children without and those with air encircling the intussusceptum.
  
  
  CONCLUSIONS
  In the presence of air encircling the intussusceptum in the distal small bowel on air enema, delayed repeated attempts for intussusception reduction are unlikely to succeed, and surgery is indicated.
authors.affiliation: Department of Medical Imaging, Hadassah - Hebrew University Medical Center, Jerusalem, Israel. ben_kop@hadassah.org.il
authors.forename: B Z
authors.initials: BZ
authors.lastname: Koplewitz
authors.forename: N
authors.initials: N
authors.lastname: Simanovsky
authors.forename: P D
authors.initials: PD
authors.lastname: Lebensart
authors.forename: R
authors.initials: R
authors.lastname: Udassin
authors.forename: K
authors.initials: K
authors.lastname: Abu-Dalu
authors.forename: D
authors.initials: D
authors.lastname: Arbell
mesh_terms: D000388:Air; D002675:Child, Preschool; D004733:Enema / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007327:Insufflation / Q000379:methods*; D007421:Intestine, Small / Q000601:surgery*; D007443:Intussusception / Q000601:surgery / Q000628:therapy*; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome