The second trial pneumatic reduction for idiopathic intussusception: therapeutic effect and hazards

Abstract

Purpose To study the therapeutic effect of the second trial pneumatic reduction on patients with idiopathic intussusception.
Patients and methods A prospective study was carried out on patients with idiopathic intussusception presenting to our unit, between August 2009 and January 2010. We excluded patients older than 2 years of age, neglected cases with signs of peritonitis, and recurrent cases. All patients were subjected to the first trial pneumatic reduction, which was performed in three successive attempts (3 min each) under fluoroscopic guidance with pressure ranging from 80 to 100 mmHg. Patients with incomplete reduction but with satisfactory movement of the intussusceptum in the first trial were subjected to a second trial pneumatic reduction after 3 h.
Results Fifty patients underwent first trial pneumatic reduction, which was successful in 33 patients, representing an overall reduction success rate of 66%. Of the remaining 17 patients, nine immediately underwent surgery rather than undergoing a second trial of pneumatic reduction because of minimal movement of the intussusceptum during the first trial. A second trial pneumatic reduction was offered to the remaining eight patients and was successful in six (75%), increasing the overall success rate from 66 to 78%. There were no bowel perforations among all the attempts at pneumatic reduction (first or second trials).
Conclusion In a selected group of patients, delayed repeated air enema can increase the nonoperative reduction rate of idiopathic intussusception; however, careful attention should be paid towards decreasing exposure to radiation.

Keywords: intussusception, pneumatic reduction, radiation dose