Treatment of intussusception with small bowel obstruction: application of decision analysis

Intussusception: factors related to treatment.

“…Several clinicians have reported that they carry out the examination for every child presenting with intussusception, provided that the correct principles of the procedure are rigorously observed,4 but some increase the pressure to as much as 14-72 kPa (150 cm H20), use bimanual manipulation, and make as many as 10 attempts at hydrostatic reduction. 1 3The risk of perforating the bowel during barium enema reduction is less than 1%,5 6 and bowel resection because of irreducibility or non-viability is necessary in about 12%. [7][8][9][10][11] Signs of peritonitis or bowel perforation are absolute contraindications to hydrostatic reduction, but there is no consensus about the duration of symptoms (over 24 or 48 hours) and evidence of small bowel obstruction.…”

Ischemic Stricture and Perforation

“…He was again discharged from the hospital but returned 2 weeks later with a temperature of 39.0°C, pulse of 190 beats per minute, vomiting, and severe diarrhea. His white blood cell count was 16.3 X10V L, with 0.76 segmented neutrophils, 0.20 band cells, and 0.03 lymphocytes. The abdomen was quiet, distended, and slightly tender.…”

49-Year-Old Woman With Acute Abdominal Pain and Nausea

“…The use of a long intestinal tube has been shown to be potentially useful in selected cases of small bowel obstruction but is generally reserved for patients with high operative risks. 3,4 Hydrostatic reduction with a barium enema is primarily used for intestinal intussusception 5 and is not suitable for small bowel obstruction of other causes. Additionally, hydrostatic reduction is associated with an increased risk of perforation in patients with small bowel obstruction.…”