Reduction of Intussusception by Barium Enema

Ultrasound guided hydrostatic reduction of intussusception in children by saline enema: our experience

“…In 1952, Ravitch and McCune published a famous landmark series from Johns Hopkins hospital in USA; they used barium sulphate enema to diagnose as well as reduce intussusception, calling this "hydrostatic reduction". Ravitch and McCune reported 73.6 % success rate, no deaths and 5.55 % recurrence rate in their original study [4].…”

“…Intestinal perforation due to over-insuffl ation with air or fl uid is a risk but most cases of perforation with reduction are said to have occurred before the procedure and as such these are "unavoidable" [4,16,17,21].…”

“…Most studies yield low successful reduction rates for ileo-cecal or ileoileocolic intussusception and higher rates for colocolic type of intussusception; this has never been adequately explained [4,14,15,16]. One study in which intracolonic pressure generated during air-insuffl ation to reduce intussusception was studied found "the area of greatest resistance (to hydrostatic reduction) is the region of ileocecal valve" [21].…”

Contrast media in intussusception

“…The respondents have experienced a low incidence of colon perforation. It is apparent, how-ever, that even in the most experienced hands perforation may occur as it may at surgery during manual reduction [7,8]. If the infant or child with intussusception is properly evaluated prior to referral to radiology for diagnosis and treatment, and the study is performed with due caution and in a conventional manner [9] utilizing barium, it is not substandard care if a colon perforation should occur.…”

Intussusception: An anatomical perspective with review of the literature

“…Greater intestinal mobility is considered a cause of intussusception and could also decrease the chance of strangulation and allow for easier reduction (Cooke and Lewis, 1960;Jona, 1986). (Clubbe, 1921) First successful surgical resection in a child Elder, 1910 Stressed early diagnosis and advised on the proper technique when performing manual surgical reduction using the gentle milking technique Hipsley, 1926 First successful hydrostatic reduction using saline Ravitch and McCune, 1948 Popularized use of barium enema as a diagnostic and therapeutic tool Bowerman et al, 1982 Introduced ultrasonography as an effective diagnostic tool for intussusceptions Guo et al, 1986 Described their successes with an air-pressure enema in 6,396 patients over a 13-year period Pracros et al, 1987 Reported 100% accuracy of sonography for the diagnosis of intussusception Saxton et al, 1994 Repeat delayed air enemas substantially increase the nonoperative reduction rate…”