Pediatric Radiology

, Volume 45, Issue 5, pp 667–674 | Cite as

Current methods for reducing intussusception: survey results

  • Rebecca Stein-WexlerEmail author
  • Rachel O’Connor
  • Heike Daldrup-Link
  • Sandra L. Wootton-Gorges
Original Article



Intussusception is a common pediatric abdominal emergency, treated with image-guided reduction. Available techniques include fluoroscopic and ultrasonographic monitoring of liquid and air.


The purpose of this study was to determine current practices and establish trends by comparing our findings with reports of previous surveys.

Materials and methods

This study is based on an e-mail survey sent to all 1,538 members of the Society for Pediatric Radiology. It included questions about demographics, presence of parents/surgeon during procedure, patient selection/preparation, use of sedation, preferred methods of reduction and technical details, approach to unsuccessful reduction, and self-reported incidence of success/perforation.


The 456 respondents (30%) reported attempting 3,834 reductions in the preceding 12 months. Of these, 96% use fluoroscopy and 4% use US guidance for reduction; 78% use air, 20% prefer fluid; 75% require intravenous access; 63% expect a surgeon to be present in hospital; 93% do not sedate. Although inflating a rectal balloon is controversial, 39% do so, and 50% employ a pressure-release valve. Seventy-two percent attempt reductions three times in the same position. In case of unsuccessful reductions, 64% wait and re-attempt later, 19% apply manual pressure, and 15% try again in left decubitus position. About 20% reattempt reduction after waiting 2 h or more.


By providing a better understanding of both trends in and diversity of current practice, we hope to increase the confidence with which the individual practitioner will approach each case.


Intussusception Intussusception reduction Practice patterns Survey Pediatric 



We would like to acknowledge the assistance of Dr. Mark Lubell, Department of Environmental Science and Policy, University of California, Davis, in developing the survey.

Conflicts of interest

Dr. Stein-Wexler has a small financial interest in Lucy LLC, a company that produces a simulation device for learning intussusception reduction.


  1. 1.
    Bisset GS 3rd, Kirks DR (1988) Intussusception in infants and children: diagnosis and therapy. Radiology 168:141–145CrossRefPubMedGoogle Scholar
  2. 2.
    Daneman A, Navarro O (2004) Intussusception. Part 2: an update on the evolution of management. Pediatr Radiol 34:97–108, quiz 187CrossRefPubMedGoogle Scholar
  3. 3.
    Del-Pozo G, Albillos JC, Tejedor D et al (1999) Intussusception in children: current concepts in diagnosis and enema reduction. Radiographics 19:299–319CrossRefPubMedGoogle Scholar
  4. 4.
    McAlister WH (1998) Intussusception: even hippocrates did not standardize his technique of enema reduction. Radiology 206:595–598CrossRefPubMedGoogle Scholar
  5. 5.
    McDermott VG (1994) Childhood intussusception and approaches to treatment: a historical review. Pediatr Radiol 24:153–155CrossRefPubMedGoogle Scholar
  6. 6.
    Davis CF, McCabe AJ, Raine PA (2003) The ins and outs of intussusception: history and management over the past fifty years. J Pediatr Surg 38:60–64CrossRefPubMedGoogle Scholar
  7. 7.
    Daneman A, Alton DJ (1996) Intussusception. Issues and controversies related to diagnosis and reduction. Radiol Clin North A 34:743–756Google Scholar
  8. 8.
    Ko HS, Schenk JP, Troger J et al (2007) Current radiological management of intussusception in children. Eur Radiol 17:2411–2421CrossRefPubMedGoogle Scholar
  9. 9.
    Peh WC, Khong PL, Chan KL et al (1996) Sonographically guided hydrostatic reduction of childhood intussusception using Hartmann’s solution. AJR Am J Roentgenol 167:1237–1241CrossRefPubMedGoogle Scholar
  10. 10.
    Khong PL, Peh WC, Lam CH et al (2000) Ultrasound-guided hydrostatic reduction of childhood intussusception: technique and demonstration. Radiographics 20:E1CrossRefPubMedGoogle Scholar
  11. 11.
    Meyer JS, Dangman BC, Buonomo C et al (1993) Air and liquid contrast agents in the management of intussusception: a controlled, randomized trial. Radiology 188:507–511CrossRefPubMedGoogle Scholar
  12. 12.
    Hadidi AT, El Shal N (1999) Childhood intussusception: a comparative study of nonsurgical management. J Pediatr Surg 34:304–307CrossRefPubMedGoogle Scholar
  13. 13.
    Shiels WE 2nd, Maves CK, Hedlund GL et al (1991) Air enema for diagnosis and reduction of intussusception: clinical experience and pressure correlates. Radiology 181:169–172CrossRefPubMedGoogle Scholar
  14. 14.
    Curtis JL, Gutierrez IM, Kirk SR et al (2010) Failure of enema reduction for ileocolic intussusception at a referring hospital does not preclude repeat attempts at a children’s hospital. J Pediatr Surg 45:1178–1181CrossRefPubMedGoogle Scholar
  15. 15.
    Blanch AJ, Perel SB, Acworth JP (2007) Paediatric intussusception: epidemiology and outcome. Emerg Med Austalas 19:45–50CrossRefGoogle Scholar
  16. 16.
    Campbell JB (1989) Contrast media in intussusception. Pediatr Radiol 19:293–296CrossRefPubMedGoogle Scholar
  17. 17.
    Meyer JS (1992) The current radiologic management of intussusception: a survey and review. Pediatr Radiol 22:323–325CrossRefPubMedGoogle Scholar
  18. 18.
    Katz ME, Kolm P (1992) Intussusception reduction 1991: an international survey of pediatric radiologists. Pediatr Radiol 22:318–322CrossRefPubMedGoogle Scholar
  19. 19.
    Schmit P, Rohrschneider WK, Christmann D (1999) Intestinal intussusception survey about diagnostic and nonsurgical therapeutic procedures. Pediatr Radiol 29:752–761CrossRefPubMedGoogle Scholar
  20. 20.
    Jewell FM, Roobottom C, Duncan A (1995) Variations in the radiological management of intussusception: results of a postal survey. Br J Radiol 68:13–18CrossRefPubMedGoogle Scholar
  21. 21.
    Rosenfeld K, McHugh K (1999) Survey of intussusception reduction in England, Scotland and Wales: how and why we could do better. Clin Radiol 54:452–458CrossRefPubMedGoogle Scholar
  22. 22.
    Hannon E, Williams R, Allan R et al (2014) UK intussusception audit: a national survey of practice and audit of reduction rates. Clin Radiol 69:344–349CrossRefPubMedGoogle Scholar
  23. 23.
    Stephenson CA, Seibert JJ, Strain JD et al (1989) Intussusception: clinical and radiographic factors influencing reducibility. Pediatr Radiol 20:57–60CrossRefPubMedGoogle Scholar
  24. 24.
    Barr LL, Stansberry SD, Swischuk LE (1990) Significance of age, duration, obstruction and the dissection sign in intussusception. Pediatr Radiol 20:454–456CrossRefPubMedGoogle Scholar
  25. 25.
    Gorenstein A, Raucher A, Serour F et al (1998) Intussusception in children: reduction with repeated, delayed air enema. Radiology 206:721–724CrossRefPubMedGoogle Scholar
  26. 26.
    Tareen F, Ryan S, Avanzini S et al (2011) Does the length of the history influence the outcome of pneumatic reduction of intussusception in children? Pediatr Surg Int 27:587–589CrossRefPubMedGoogle Scholar
  27. 27.
    Fike FB, Mortellaro VE, Holcomb GW 3rd et al (2012) Predictors of failed enema reduction in childhood intussusception. J Pediatr Surg 47:925–927CrossRefPubMedGoogle Scholar
  28. 28.
    Del-Pozo G, Gonzalez-Spinola J, Gomez-Anson B et al (1996) Intussusception: trapped peritoneal fluid detected with US — relationship to reducibility and ischemia. Radiology 201:379–383CrossRefPubMedGoogle Scholar
  29. 29.
    Britton I, Wilkinson AG (1999) Ultrasound features of intussusception predicting outcome of air enema. Pediatr Radiol 29:705–710CrossRefPubMedGoogle Scholar
  30. 30.
    Kong MS, Wong HF, Lin SL et al (1997) Factors related to detection of blood flow by color Doppler ultrasonography in intussusception. J Ultrasound Med 16:141–144PubMedGoogle Scholar
  31. 31.
    Touloukian RJ, O’Connell JB, Markowitz RI et al (1987) Analgesic premedication in the management of ileocolic intussusception. Pediatrics 79:432–434PubMedGoogle Scholar
  32. 32.
    Ilivitzki A, Shtark LG, Arish K et al (2012) Deep sedation during pneumatic reduction of intussusception. Pediatr Radiol 42:562–565CrossRefPubMedGoogle Scholar
  33. 33.
    Hsiao JY, Kao HA, Shih SL (1988) Intravenous glucagon in hydrostatic reduction of intussusception: a controlled study of 63 patients. Zhonghua Minguo Xiao Er Ke Yi Xue Hui 29:242–247Google Scholar
  34. 34.
    Franken EA Jr, Smith WL, Chernish SM et al (1983) The use of glucagon in hydrostatic reduction of intussusception: a double-blind study of 30 patients. Radiology 146:687–689CrossRefPubMedGoogle Scholar
  35. 35.
    Schmitz-Rode T, Müller-Leisse C, Alzen G (1991) Comparative examination of various rectal tubes and contrast media for the reduction of intussusceptions. Pediatr Radiol 21:341–345CrossRefPubMedGoogle Scholar
  36. 36.
    Daneman A, Alton DJ, Ein S et al (1995) Perforation during attempted intussusception reduction in children — a comparison of perforation with barium and air. Pediatr Radiol 25:81–88CrossRefPubMedGoogle Scholar
  37. 37.
    Phelan E, de Campo JF, Malecky G (1988) Comparison of oxygen and barium reduction of ileocolic intussusception. AJR Am J Roentgenol 150:1349–1352CrossRefPubMedGoogle Scholar
  38. 38.
    Beres AL, Baird R (2013) An institutional analysis and systematic review with meta-analysis of pneumatic versus hydrostatic reduction for pediatric intussusception. Surgery 154:328–334CrossRefPubMedGoogle Scholar
  39. 39.
    Sargent MA, Wilson BP (1991) Are hydrostatic and pneumatic methods of intussusception reduction comparable? Pediatr Radiol 21:346–349CrossRefPubMedGoogle Scholar
  40. 40.
    Grasso SN, Katz ME, Presberg HJ et al (1994) Transabdominal manually assisted reduction of pediatric intussusception: reappraisal of this historical technique. Radiology 191:777–779CrossRefPubMedGoogle Scholar
  41. 41.
    Vazquez JL, Ortiz M, Doniz MC et al (2012) External manual reduction of paediatric idiopathic ileocolic intussusception with US assistance: a new, standardised, effective and safe manoeuvre. Pediatr Radiol 42:1197–1204CrossRefPubMedGoogle Scholar
  42. 42.
    Vazquez JL, Ortiz M, Doniz MC et al (2012) External manual reduction of paediatric idiopathic ileocolic intussusception with ultrasound assistance. Pediatr Radiol 42:1195–1196CrossRefPubMedGoogle Scholar
  43. 43.
    Saxton V, Katz M, Phelan E et al (1994) Intussusception: a repeat delayed gas enema increases the nonoperative reduction rate. J Pediatr Surg 29:588–589CrossRefPubMedGoogle Scholar
  44. 44.
    Connolly B, Alton DJ, Ein SH et al (1995) Partially reduced intussusception: when are repeated delayed reduction attempts appropriate? Pediatr Radiol 25:104–107CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Rebecca Stein-Wexler
    • 1
    Email author
  • Rachel O’Connor
    • 2
  • Heike Daldrup-Link
    • 3
  • Sandra L. Wootton-Gorges
    • 1
  1. 1.Department of Radiology Pediatric radiology sectionUniversity of California, Davis Medical CenterSacramentoUSA
  2. 2.Department of RadiologyUniversity of California, Davis, Medical CenterSacramentoUSA
  3. 3.Department of Radiology Pediatric radiology sectionLucile Packard Children’s Hospital, Stanford School of MedicineStanfordUSA

Personalised recommendations