Intussusception in infants and children, with emphasis on the recognition of cases with complications.

Abstract

Intussusception has been described by many authors (1–5) as the commonest cause of acquired intestinal obstruction in infants and children. Experience at the Children's Hospital would seem to indicate that, in the absence of complications, intussusception does not generally produce roentgenologic and/or clinical signs of obstruction. Recent reports point to radiologically controlled hydrostatic pressure reduction as the best treatment for uncomplicated intussusception in infants and children (6–8). This is believed to be less traumatic to the bowel than manual reduction at open operation, a view which is supported by the appreciable incidence of mechanical intestinal obstruction from adhesions occurring after open reduction (9,10). The chief objections still raised to reduction of intussusception by hydrostatic pressure are, first, that gangrenous bowel may be reduced, and second, that devitalized bowel may perforate under the pressure. The clinical and experimental work of Ravitch and McCune (6, 7) has demonstrated that, with controlled hydrostatic pressure, there is little or no danger of these complications. The Danish and Australian investigators (11–15) who pioneered in the use of this method have, with their followers, successfully treated many hundreds of patients, providing an impressive testimonial for the safety of the procedure. It would be even more impressive and convincing to pediatricians and surgeons if we could with assurance differentiate complicated and uncomplicated cases of intussusception before attempting reduction by barium enema. Hydrostatic pressure reduction is contraindicated in the presence of complications. The most common complications of intussusception are gangrene of the intussuscepted bowel, peritonitis as a result of migration of organisms through the intact wall of viable intussuscepted bowel, and the presence of an underlying tumor or other lesion as a leading point. The records of 42 children treated for intussusception at the Children's Hospital from 1947 to 1952, inclusive, were reviewed in an effort to determine if such complications could be predicted before the institution of treatment. Hydrostatic pressure reduction was successful in 3 cases, in 1 of which operation had been done at each of two previous admissions for apparently uncomplicated intussusception. The remaining 39 cases were surgically explored following preliminary roentgen studies and barium enema. In the majority of these cases the examination was terminated at the request of the surgeon as soon as the diagnostic features were observed. We were thereby provided a series of cases, small but conclusive, in which the roentgen criteria for the presence of complications could be tested by direct inspection of the involved bowel. Thirty-two of the operated cases were found to be uncomplicated. Complications of varying nature were present in the remaining 7 cases.