Abstract
This paper compares the effects on patients of perforation with barium and with air during attempted intussusception reduction by reviewing the clinical, radiological, surgical and pathological findings and sequelae in seven children who received barium and seven who received air. In both groups perforation occurred in infants under 6 months of age (with one exception) with a long duration of symptoms. All patients with barium enema required resection of bowel whereas only four with air enema required resection. Anesthetic times were longer in those patients with barium perforation in whom the intussusception did not move and there was a large leak. The patients with perforation due to air had a shorter hospital stay with decreased morbidity compared to those with perforation due to barium. Perforation occurred through areas of transmural necrosis in a minority of patients in each group. Perforations through normal bowel and shear injury (with air enema) indicate that increased pressure during the examination is an important factor in some patients. Because perforation with air is so much easier to deal with surgically and the children do better clinically, there is a tendency for some to consider perforation with air an inconsequential situation. However, a potential rare complication with this technique is tension pneumoperitoneum. Keeping this in mind, we continue to use air as the contrast of choice because the procedure in our hands is a safe, quicker and easier technique and we have achieved a substantial improvement in reduction rates. Overall reported perforation rates with air enema compare favourably with those due to barium enema.
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Guo J, Ma X, Zhou Q (1986) Results of air pressure enema reduction of intussusception: 6,396 cases in 13 years. J Pediatr Surg 21: 1201–1203
Jinzhe Z, Yenxia W, Linchi W (1986) Rectal inflation reduction of intussusception in infants. J Pediatr Surg 21: 30–32
Ya-Hsiung S, Wen-Hsiang T, Hsin-Hua Y (1964) Reduction of intestinal intussusception in infancy by colonic air insufflation. Chin Med J (Engl) 83: 668–673
Ya-Xiong S (1982) Traitement de l'invagination intestinale avec regard special sur la reduction par l'insufflation du colon. Chir Pediatr 23: 373–378
Gu L, Wong S, Gu A (1993) Perforations during attempted intussusception reduction: 14 patients from 9,028 examinations over a 20 year period. J Intervent Radiol 2: 36–38
Tamanaha K, Wimbish K, Talwalkar Y, Ashimine K (1987) Air reduction of intussusception in infants and children. J Pediatr 111: 733–736
Fiorito E, Cuestas L (1959) Diagnosis and treatment of acute intestinal intussusception with controlled insufflation of air. Pediatrics 24: 241–244
Gu L, Alton D, Daneman A, Stringer D, Liu P, Wilmot D, Reilly B (1988) Intussusception reduction in children by rectal insufflation of air. AJR 150: 1345–1348
Phelan E, de Campo J, Malecky G (1988) Comparison of oxygen and barium reduction of ileocolic intussusception. AJR 150: 1349–1352
Miles S, Cumming W, Williams J (1988) Pneumatic reduction of ileocolic intussusception in children. Pediatr Radiol 18: 3–5
Bisset G III, Kirks D (1988) Intussusception in infants and children: diagnosis and therapy. Radiology 168: 141–145
de Campo J, Phelan E (1989) Gas reduction of intussusception. Pediatr Radiol 19: 297–298
Shiels (II) W, Maves C, Hedlund G, Kirks D (1991) Air enema for diagnosis and reduction of intussusception: clinical experience and pressure correlates. Radiology 181: 169–172
Stringer M, Pablot S, Brereton R (1992) Paediatric intussusception. Br J Surg 79: 867–876
Stein M, Alton D, Daneman A (1992) Pneumatic reduction of intussusception: 5-year experience. Radiology 183: 681–684
Humphry A, Ein S, Mok P (1981) Perforation of the intussusception colon. AJR 137: 1135–1138
Almond CH, Cochran DQ, Shucart WA (1961) Comparative study of the effects of various radiographic contrast media on the peritoneal cavity. Ann Surg 154 [Suppl]: 219–224
Cochran DQ, Almond CH, Shucart WA (1963) An experimental study of the effects of barium and intestinal contents on the peritoneal cavity. AJR 89: 883–887
Sisel RJ, Donovan AJ, Yellin AE (1972) Experimental fecal peritonitis: influence of barium sulfate or water-soluble radiographic contrast material on survival. Arch Surg 104: 765–768
Ginai AZ (1985) Experimental evaluation of various available contrast agents for use in the gastrointestinal tract in case of suspected leakage: effects on peritoneum. Br J Radiol 58: 969–978
Shiels (II) W, Kirks D, Keller G, Ryckman F, Daugherty C, Specker B, Summa D (1993) Colonic perforation by air and liquid enemas: comparison study in young pigs. AJR 160: 931–935
Ein S, Mercer S, Hymphry A, Macdonald P (1981) Colon perforation during attempted barium enema reduction of intussusception. J Pediatr Surg 16: 313–315
Bramson R, Blickman J (1992) Perforation during hydrostatic reduction of intussusception: proposed mechanism and review of the literature. J Pediatr Surg 27: 589–591
Armstrong E, Dunbar J, Graviss E (1980) Intussusception complicated by distal perforation of the colon. Radiology 136: 77–81
Campbell J (1989) Contrast media in intussusception. Pediatr Radiol 19: 293–296
Riebel TW, Nasir R, Weber K (1993) Ultrasound guided hydrostatic reduction of intussusception in children. Radiology 188: 513–516
Woo S, Kim J, Suh S, Paik T, Choi S (1992) Childhood intussusception: ultrasound guided hydrostatic reduction. Radiology 182: 77–80
Bolia A (1985) Case report: diagnosis and hydrostatic reduction of an intussusception under ultrasound guidance. Clin Radiol 36: 655–657
Wang G, Liu S (1988) Enema reduction of intussusception by hydrostatic pressure under ultrasound guidance: a report of 377 cases. J Pediatr Surg 23: 814–818
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Daneman, A., Alton, D.J., Ein, S. et al. Perforation during attempted intussusception reduction in children —a comparison of perforation with barium and air. Pediatr Radiol 25, 81–88 (1995). https://doi.org/10.1007/BF02010311
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DOI: https://doi.org/10.1007/BF02010311