Delayed Repeat Contrast Enema for Treatment of Pediatric Intussusception

• Published in: The Journal of surgical research Vol. 275; pp. 109 - 114
• Main Authors: Radu, Stephanie, Lin, Saunders, Le, Louis D., Fialkowski, Elizabeth, Zigman, Andrew
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2022
• Subjects: Child; Enema - adverse effects; Enema - methods; Humans; Ileal Diseases - diagnostic imaging; Ileal Diseases - surgery; Ileocolic intussusception; Infant; Intussusception; Intussusception - diagnostic imaging; Intussusception - therapy; Protocol implementation; Repeat enema; Retrospective Studies; Treatment Outcome; Protocol implementation; Ileocolic intussusception; Intussusception; Repeat enema
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2022.01.008

Ileocolic intussusception is a common cause of pediatric bowel obstruction. Contrast enema is successful in treating the majority of patients, and if initially unsuccessful, approximately one-third may be reduced with repeat enemas. We sought to study protocol implementation for delayed repeat enema in pediatric patients not reduced completely by an initial contrast enema. Our aims were to assess repeat enema success rates and outcome differences in preprotocol and postprotocol patients with respect to (1) intussusception recurrence, (2) surgical intervention and complication rates, and (3) length of stay. We performed a retrospective review of treatment and clinical outcomes prior to and following protocol implementation for repeat enema for intussusception at two tertiary pediatric referral hospitals. The preprotocol period was defined from 2/2013 to 2/2016, and the postprotocol period was from 8/2016 to 11/2019. There were 112 patients in the preprotocol group, with 74 (66%) having successful reduction following the first enema. Of the 38 patients without successful reduction, 16 (42%) patients underwent repeat enema, and five were successful (31%). The postprotocol group included 122 patients, with 84 (69%) having successful first reduction. Of the 38 patients that failed, 25 patients (66%) underwent repeat enema, of which 13 (52%) were successful. Compared to preprotocol patients, postprotocol patients had significantly more enemas repeated and a trend toward fewer surgical interventions. Protocol implementation of repeat delayed enemas was significantly associated with an increased rate of repeat enemas at our institutions and reduced need for operative intervention during the index stay. •Protocol implementation of delayed repeat enema is associated with a significantly increased rate of repeat enemas at our institutions.•Protocolized delayed repeat enema is associated with a trend toward reduced need for surgery for intussusception. • Protocolized implementation of delayed repeat enema may improve patient outcomes by safely avoiding surgery with additional nonoperative reduction attempts.