Performance Under Pressure: A Retrospective Review of the Pneumatic Reduction of Ileocolic Intussusception in a Paediatric Hospital Over 17 Years

PURPOSE: Ileocolic intussusception is a paediatric emergency requiring rapid reduction of the telescoped bowel. Often initial attempts at reduction are conservative, using gas or liquid enema. Our aim is to examine the success of pneumatic reduction over the past 17 years at our centre, compare our rates of success and complication to the published literature, and evaluate the use of delayed repeat reduction attempts (DRRAs). METHODS: A retrospective single centre review of all patients with attempted pneumatic reduction of ileocolic intussusception, between January 2006 and December 2023. Patient demographics, clinical history, number of initial and delayed reduction attempts, and surgical outcomes were reviewed. RESULTS: Three hundred fourteen patients had successful reduction out of a total 375 attempted (success rate 84%). In general, the further the distal extent of the intussusceptum, the decreasing likelihood of successful pneumatic reduction (95% ascending colon; 86% hepatic flexure; 85% transverse colon; 40% splenic flexure; 50% descending colon; 35% sigmoid colon). The success also decreased with each repeat attempt in a single session, but DRRAs showed relatively increased success. Rates of bowel resection in patients transferred to theatre after initial attempts compared with DRRAs were similar (23% vs. 22%). Bowel perforation occurred in 0.8% (all during the first reduction attempt). CONCLUSIONS: This study supports the use of multiple attempts at the pneumatic reduction of ileocolic intussusception, with evidence that subsequent delayed repeat attempts after 4-6 h are effective at reducing operative intervention rates without increasing the risk of bowel perforation or resection.