- 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
Pediatric Imaging 