Reduction of intussusception by air enema in children - Experience over a 13-year period

Purpose: Intussusception is a relatively common pediatric emergency. The accepted treatment is closed reduction using barium or air enema and surgery when it has failed. We present our 13-year experience using air enema for treatment of intussusception, emphasizing the reduction with repeated delayed air enema. Methods: Between February 1990 and December 2002, air enema procedures were performed in pediatric patients in cases with suspected intussusception. Prior to the procedure, all patients were sedated with meperidine hydrochloride (0.5 mg/kg) or morphine (0.1 mg/kg). Before 1993, surgery was performed after the first ineffective attempt of air enema reduction. Since 1993, in the case of failure of the first attempt, two additional trials of air reduction were performed at an interval of 45-60 minutes prior to surgery. Results: A total of 225 air enema procedures were performed in 201 children (129 males, aged 10.4 ± 9.1 months, range 8-63 months) with suspicion of intussusception. The diagnosis was confirmed in 148 (66%) out of the 225 procedures performed. A successful reduction of intussusception (by one attempt or more) was achieved in 125 (86%) out of the 148 procedures with proved intussusception. Twenty-one (14%) patients were operated on after the failure of closed reduction. Spontaneous reduction was demonstrated under fluoroscopy in two (0.8%) studies. No complications of the air enema were noted. During 1990-1993, a single reduction attempt of the intussusception by air enema was performed. Successful reduction during this period was achieved in 19 (70%) out of 27 patients and 8 (30%) children were operated on. During the period 1993-2002, we used repeated delayed attempts to obtain reduction of intussusception among 174 patients. The success rate was 89% (108 out of 121 patients) and only 13 (11%) children were operated on. Conclusion: Air enema is an efficient and safe diagnostic and therapeutic tool for intussusception in the pediatric population.