PERFORATION DURING ATTEMPTED INTUSSUSCEPTION REDUCTION IN CHILDREN - A COMPARISON OF PERFORATION WITH BARIUM AND AIR

This paper compares the effects on patients of perforation with barium and with air during attempted intussusception reduction by reviewing the clinical, radiological, surgical and pathological findings and seq uelae in seven children who received barium and seven who received air , In both groups perforation occurred in infants under 6 months of age (with one exception) with a long duration of symptoms. All patients w ith barium enema required resection of bowel whereas only four with ai r enema required resection. Anesthetic times were longer in those pati ents with barium perforation in whom the intussusception did not move and there was a large leak, The patients with perforation due to air h ad a shorter hospital stay with decreased morbidity compared to those with perforation due to barium. Perforation occurred through areas of transmural necrosis in a minority of patients in each group. Perforati ons through normal bowel and shear injury (with air enema) indicate th at increased pressure during the examination is an important factor in some patients. Because perforation with air is so much easier to deal with surgically and the children do better clinically, there is a ten dency for some to consider perforation with air an inconsequential sit uation, However, a potential rare complication with this technique is tension pneumoperitoneum, Keeping this in mind, we continue to use air as the contrast of choice because the procedure in our hands is a saf e, quicker and easier technique and we have achieved a substantial imp rovement in reduction rates. Overall reported perforation rates with a ir enema compare favourably with those due to barium enema.