Perforation during hydrostatic reduction of intussusception: proposed mechanism and review of the literature.

Eight cases of children with intussusception in whom the bowel perforated during attempts at enema reduction are reviewed. Certain features in each case suggest that perforation may not be secondary to increased intraluminal pressure from the enema, but that necrotic perforated bowel is uncovered as the intussusception is reduced. A review of the basis for recommendations about the height of the enema bag during attempted reduction suggests that these guidelines are largely arbitrary and lack scientific support.