Enema for intussusception reduction using liquid

  • 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: high osmolar water soluble, dilute contrast using 1 part contrast : 2 parts sodium chloride if < 1 year old or 2 parts tap water if > 1 year old
  • Technique:
    — Contraindication – peritonitis
    — Tip – regular
    — Tape tip in securely
    — Position the patient prone with someone squeezing the butt cheeks together firmly
    — Gently fill the colon with barium from a bag hanging 3 feet above the fluoroscopy table
    — 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