Air enema for intussusception: is predicting the outcome important?

Air enema is the treatment of choice for childhood intussusceptions. Although peritonitis is the established contraindication, studies have attempted to identify factors that affect the outcome of air enema. In our series we studied the impact of such factors on the clinical scenario to determine if it was important to predict the outcome of air enema. We retrospectively reviewed the records of 179 children who underwent air enema for intussusception at our institution over a 5-year period. Abdominal colic was present in 144 children, vomiting in 139 and rectal bleeding in 108 children. The duration of symptoms was less than 24 h in 131 children. An abdominal mass was present in 121 children, rectal prolapse of intussusception in 14, dehydration in 31 and small bowel obstruction in 27 children. The success rate of air enema was calculated. All clinical features were analyzed for impact on outcome using univariate and multivariate analysis. The extent of this impact on the clinical scenario was examined. Air enema was successful in 157 cases (89%). One child developed a perforation during the procedure (0.6%). The recurrence rate was 8%. Using chi2 test, success of air enema was reduced in the presence of rectal bleeding, rectal prolapse of intussusception, dehydration, and small bowel obstruction. This reduction was statistically significant (P < 0.05). Using logistic regression analysis, the success of air enema was significantly reduced (P < 0.05) only in the presence of prolapsing rectal intussusception (57%) and small bowel obstruction (52%). Small bowel obstruction and prolapsing rectal intussusceptions merely reduce the success of air enema and do not increase the complications. Since the success of air enema is very high, it must be attempted in all children with the exception of peritonitis. Predicting the outcome is not crucial because of the high success rate and low complication rate.