PARTIALLY REDUCED INTUSSUSCEPTION - WHEN ARE REPEATED DELAYED REDUCTION ATTEMPTS APPROPRIATE

The imaging techniques for diagnosis and monitoring of reduction of in tussusception by fluoroscopy and ultrasound continue to evolve. The co mmon goal of all protocols is to reduce the intussusception by enema i n as many patients as possible and avoid laparotomy with its potential morbidity. We report two infants in whom the initial attempt at reduc tion by air enema only achieved partial reduction, from the descending colon to the transverse colon in one, and from the splenic flexure to the caecum in the other. Both patients became asymptomatic and clinic ally stable. In light of the clinical stability, and in consultation w ith the surgeons, laparotomy was deferred. Sonography was used to conf irm the persistence of the intussusception before repeat air enema sev eral hours later. Following three further air enemas in each child, th e intussusceptions were successfully reduced after 20 h and 24 h respe ctively. Both patients remained asymptomatic and did not require surge ry. In infants with partially reduced intussusception we suggest that if the patient becomes asymptomatic and stable, surgery can be safely delayed to permit further attempts at enema reduction. Sonography has a valuable role in determining the persistence of the intussusception prior to repeat enema. Close cooperation with the surgeon and careful clinical monitoring of the patient are essential requirements for this proposal.