Delayed Repeated Enema and Operative Findings after Unsuccessful Primary Enema for Intussusception

Abstract

The purpose of this study was (1) to evaluate the role for and the potential morbidity associated with delayed repeated enema (DRE) and (2) to compare surgical findings for patients undergoing operative exploration after failed primary enema and DRE reduction attempts for intussusception. After obtaining approval from the Internal Review Board, we completed a retrospective review of all patients treated for intussusception at a large, tertiary care pediatric hospital. We evaluated the success of primary reduction enema, DRE, and compared surgical findings after failed enema reduction. A total of 135 intussusceptions underwent an attempt at enema reduction following diagnosis. Of these, 83 (61.5%) intussusceptions were reduced with primary enema. Thirty-four patients (25.2%) proceeded directly to surgical exploration after a failed primary enema and 4 more patients were explored after successful reduction due to suspicion for a pathologic lead point. Thirty-four of these operations were therapeutic. In this, four patients had a negative exploration; eight patients required a bowel resection due to necrotic bowel, perforation, or persistence of an irreducible intussusception. Eighteen patients underwent a DRE after a failed primary enema. Two DREs revealed the intussusception had completely reduced before the study, and 11 DREs were successful in reducing persistent intussusceptions. Five patients underwent operative exploration after a failed DRE and were all found to have a persistent intussusception which was successfully reduced intraoperatively. There were no negative laparotomies, pathologic lead points, or instances of necrotic bowel or perforation in patients explored following unsuccessful DRE and no bowel resections were required. The use of DRE in select patients with persistence of an intussusception may result in successful subsequent reduction with no apparent increase in morbidity. A DRE may lead to improved outcomes for patients with intussusception through avoidance of unnecessary surgical reductions and negative explorations.