Unsuccessful air-enema reduction of intussusception: is a second attempt worthwhile?

Pneumatic reduction of idiopathic intussusception is successful in about 80 % of cases, while 60% of the failures are reduced at surgery without resect ion. To determine whether delayed, repeated attempts at enema reduction of failures would reduce the need for operation in selected cases, over a 2-ye ar period (1994-1996 inclusive), 17 infants with idiopathic intussusception underwent delayed repeat enemas 2-19 h following the first failed attempt at reduction. Clinical parameters and radiologic findings were evaluated wi th respect to outcome. Ten intussusceptions were successfully reduced after the second attempt in 9 and after the fourth attempt in 1. Seven children underwent a laparotomy, 5 because of failure of progressive reduction at ai r enema (AE). Two were taken to surgery early in the series, 1 because of p erforation during a second attempt and 1 while awaiting a third reduction a ttempt. The 10 successful reductions all showed progressive movement of the intussusceptum on each AE; the 2 who perforated failed to show progressive reduction on their second AE. Because of these cases, the remaining 5 were referred to surgery because of failure of progressive reduction of the int ussusceptum on the second attempt. At laparotomy, of the 7 unsuccessful red uctions, 4 required resection and 3 had difficult manual reduction. The pre sence of vomiting, a mass, and/or bloody stools were not predictors of outc ome. Failures had higher body temperatures (38.1 +/- 0.3 vs 37.4 +/- 0.1 de grees C, P = 0.07), heart rates (153.7 +/- 8 vs 136.9 +/- 2.1 min, P = 0.03 ), and longer duration of symptoms (36.8 +/- 4 vs 21.3 +/- 3.6 h; P = 0.01) than successes. Delayed repeat AEs may be safe and effective in selected c ases of idiopathic intussusception, but should be considered only if signif icant movement of the intussusceptum is noted at each attempt. The ideal ti me for repeat AE reduction prior to surgery is not established, but 2-4 h a ppears appropriate. Pyrexia, tachycardia, and duration of symptoms greater than 36 h are relative contraindications to this course of management.