Enema for intussusception reduction using air

  • Patient preparation: patient needs to have been seen by pediatric surgery prior to enema, needs an IV in place, consider 1 dose of IV antibiotics before the procedure
  • Contrast used: air
  • Technique:
    — Have 16 or 18 gauge needle readily available to reduce a tension pneumoperitoneum in case of perforation
    — Contraindication – peritonitis
    — Use the small blue enema tip for child < 7 months old, use large pink enema tip for child > 7 months old
    — Tape tip in securely
    — Position the patient prone with someone squeezing the butt cheeks together firmly
    — Gently fill the colon with air
    — Never exceed 120 mm Hg of pressure
    — Make 3 attempts to reduce the intussusception, each lasting for 3 minutes
    — Be sure to reflux the terminal ileum completely, otherwise you cannot be sure you have completely reduced the intussusception
  • Images to obtain: scout AXR to start, images of lead point being reduced, overhead image when done to make sure intussusception has not recurred
  • Looking for: complete reduction of intussusception
  • Post procedure tasks: 10% recur within 24 hours – repeat US to look for intussusception if patient redevelops symptoms