Indications and contraindications for conservative and operative methods of treatment of intussusception in children

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INDICATIONS AND CONTRAINDICATIONS:

• Provide rehydration and stabilization as needed in patients with intussusception.

• Contrast enema is diagnostic in approximately 95% of intussusception cases. It is therapeutic and curative in most cases with less than 24-hour duration.

• In children, the therapy of choice is reduction via barium enema, hydrostatics, or pneumatics.Although barium is generally used, water-soluble contrast agents have the advantage of not staining the peritoneum should a perforation occur. Pneumatic reduction has become increasingly popular as a clean, efficient technique.

• The use of air also allows for reduced radiation exposure compared to barium enemas. Pneumatic reduction involves pressurized air pumped into the rectum and colon via an insufflation device. Target pressures range between 80 and 120 mm Hg for successful reduction.

• Patients aged 5 months to 3 years who have intussusception rarely have a lead point (ie, idiopathic intussusception) and are usually responsive to nonoperative reduction.

• Older children and adults more often have a surgical lead point to the intussusception and require operative reduction

• The presence of peritonitis and any evidence of perforation revealed on plain radiographs are the only 2 absolute contraindications to an attempt at nonoperative reduction with a therapeutic enema.

• If nonoperative reduction is unsuccessful or if obvious perforation is present, promptly refer the infant for surgical care

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