title: Needle decompression to avoid tension pneumoperitoneum and hemodynamic compromise after pneumatic reduction of pediatric intussusception.
abstract: BACKGROUND
  The contemporary management of children with ileocolic intussusception often includes pneumatic reduction. While failure of the procedure or recurrence after reduction can result in the need for surgical treatment, more serious adverse sequelae can occur including perforation and, rarely, tension pneumoperitoneum. During the last year, four cases of perforation during attempted pneumatic reductions complicated by tense pneumoperitoneum have occurred in our center.
  
  
  OBJECTIVE
  We have elected to report our patient experience, describe methods of management and review available literature on this uncommon but serious complication.
  
  
  METHODS
  Using ICD-9 diagnosis codes, we reviewed the records of children with intussusception during 2011. Demographic and therapeutic clinical data were collected and summarized.
  
  
  RESULTS
  During the study period, 101 children with intussusception were treated at our institution, with 19% (19/101) of them requiring surgical intervention. Four children (4%) experienced a tense pneumoperitoneum during air enema reduction, prompting urgent needle decompression in the fluoroscopy suite. These children required bowel resection during subsequent laparotomy. No deaths occurred.
  
  
  CONCLUSIONS
  Pneumoperitoneum is a real and life-threatening complication of pneumatic enemas. It requires immediate intervention and definitive surgical management. Caution should be exercised by practitioners performing this procedure at institutions where pediatric radiology experience is limited and immediate pediatric surgical support is not available.
authors.affiliation: Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Sara C
authors.initials: SC
authors.lastname: Fallon
authors.forename: Eugene S
authors.initials: ES
authors.lastname: Kim
authors.forename: Bindi J
authors.initials: BJ
authors.lastname: Naik-Mathuria
authors.forename: Jed G
authors.initials: JG
authors.lastname: Nuchtern
authors.forename: Christopher I
authors.initials: CI
authors.lastname: Cassady
authors.forename: Jose Ruben
authors.initials: JR
authors.lastname: Rodriguez
mesh_terms: D002648:Child; D002675:Child, Preschool; D019299:Decompression, Surgical / Q000295:instrumentation*; D005260:Female; D006801:Humans; D007327:Insufflation / Q000009:adverse effects* / Q000379:methods*; D007443:Intussusception / Q000150:complications / Q000517:prevention & control*; D008297:Male; D009339:Needles; D011027:Pneumoperitoneum / Q000209:etiology* / Q000517:prevention & control*; D016896:Treatment Outcome