Although some patients may require surgery,
particularly with signs
of ischemia or perforation,
the vast majority of patients
respond quite well to
There are a couple of options.
There's therapeutic enemas.
This is a hydrostatic reduction
where a column of barium
is inserted into the rectum
at a certain height.
This height is optimized to
both reduce the intussusception,
but also to minimize
the risk of perforation.
This can be performed hydrostatically
with either contrast barium
or water-soluble contrast.
pneumatic or air enemas
have increasing use in patients
with reduction of intussusception.
There's no need for
barium in this situation.
Both have fairly good success.
Please also keep in mind, this is not as
useful if it's not ileocolic.
In any other portions of the intestines,
pneumatic or therapeutic hydrostatic enemas
may not be able to reduce
more proximal to the section.
It is worth mentioning that in 10% of cases,
intussusception recurs after reduction.
Now, in this situation
where patients do not reduce
intussusception with the enemas therapy,
there are some indications for surgery.
if the patient develops peritonitis,
they may not be able to
present with classic findings
of peritonitis as in adults.
Everything generally just hurts.
But if you find that there
is discoloration of the skin,
this may be a sign of peritonitis.
This suggests likely perforated.
Although you don't know
where the perforation is,
this is an absolute indication for surgery.
as is in the case with most kids,
progressive clinical deterioration.
As a reminder,
if a clinical scenario is presented to you
and the patient has suspicion for ischemia
or clinical deterioration,
I strongly recommend that
you go to the operating room.
In the operating room,
this is how we take care
that you push the invaginated segment out
rather than pulling it out.
This reduces the perforation risk.
It’s common physics.
If you're successful
or not successful,
management is a little bit different.
If you're able to reduce
intussusception in children
by simply pushing out the invaginated segment
and the segments appear viable,
then complete the procedure
by doing an appendectomy.
if you are not easily able
to reduce intussusception,
it’s probably safer to
perform a segmental resection.
Let's review some very
important clinical pearls
and high-yield information.
In patients who do not
succeed an enema reduction,
they can be repeated.
if a patient initially
succeeds with enema reduction
they’re also a candidate for enema reduction
as long as these patients
do not demonstrate any
signs or indications for surgery
that we've discussed.
And for your examination,
lead points are rare in children.
Lymph nodes, however,
is the most common lead point,
usually following upper respiratory infection.
if an intussusception is presented
in an adult patient,
think about cancer
as most patients –
adult patients with intussusception
have a lead point
to explain why they develop
Thank you very much for joining me
on this discussion of intussusception.