The changing face of intussusception.

Management of intussusception in a pediatric center shows changing patterns over the past 26 years. Early and subacute cases of intussusception are now ordinarily successfully reduced by hydrostatic pressure (barium enema). A minority, who are in shock, who have evidence of significant blood loss or, in whom small intestinal obstruction is apparent, are treated by emergency laparotomy, with or without confirmatory contrast studies. In the latter group the rate of resection is high (16.4% in the present series). Resected segments are microscopically infarcted; with unnecessary resection a rarity. Advances in surgical management have eliminated a major portion of the mortality formerly associated with resection. The use of hydrostatic pressure reduction makes surgery unnecessary in a high percentage of infants with intussusception, but does not reduce the incidence of infarction requiring resection. Ambulatory or nonhospital management of intussusception subjects the infant to the risk of a significant delay in definitive treatment and is not to be condoned.