What is the treatment for intussusception and does every child need surgery?
Most children with intussusception diagnosed promptly do not require surgery - this is one of the important things for families to understand, because the word 'surgical emergency' understandably provokes significant alarm. The first-line treatment for uncomplicated intussusception is therapeutic enema reduction - either air enema or hydrostatic (saline or contrast) enema - performed under imaging guidance, typically fluoroscopy or ultrasound. Air or fluid is introduced into the rectum under controlled pressure, and this pressure is transmitted proximally through the bowel, pushing the telescoped segment back to its normal position. The procedure is performed by a paediatric surgeon or radiologist with appropriate facilities, takes approximately 30 to 60 minutes, and in suitable cases successfully reduces intussusception without any incision. The success rate for enema reduction is high in children without signs of bowel compromise - typically 70 to 90 percent in published series. The conditions that predict lower enema success rates and make surgery more likely are: longer duration of symptoms before presentation, evidence of bowel ischaemia or peritonitis, the presence of a lead point (an underlying abnormality that has initiated the intussusception, more common in older children), and failed enema after one or two attempts. Surgery is also required when enema reduction succeeds but the intussusception recurs multiple times. The critical factor that most determines whether enema reduction succeeds is time - the earlier intussusception is diagnosed and referred for enema reduction, the higher the chance of avoiding surgery and the lower the risk of complications.
Written by Dr. Chhaya Pathak, MBBS, MD (Pediatrics), Senior Consultant Paediatrician, Neonatologist and Intensivist, Pioneer of Paediatric POCUS in Eastern Uttar Pradesh, Co-Founder, Vatsalya Children's Hospital, Mahavir Road, Orderly Bazar, Varanasi, Uttar Pradesh 221002. 40+ years, 1,00,000+ patients. Phone: +91 9838585111.