Protocol for Enema Reduction of Intussusceptions  

A.  Ensure the following:

  1. Patient has an IV in place
  2. Patient is monitored (O2 sat & cardiac)
  3. Nurse accompanies patient and remains in the room at ALL times
  4. Pediatric surgery is aware of the procedure in the event the patient needs to be rushed to the OR.
 

B.  Radiology:

  1.       Obtain:

    1. US has already been performed and is positive
    2. Scout film
    3. Decubitus film (check for free air, a contraindication)
    4. Consent
    5. History: the longer the patient has been symptomatic, the more difficult it will be to reduce and risk of perforation is increased.
  1. Water-soluble contrast Cysto-Conray II (dilute 50:50 with saline)
    1. Room temperature or slightly warm
  2. Use largest Foley catheter possible and tape buttocks tightly with plastic tape {no balloon}.
  3. Position bag three (3) feet above the tabletop
  4. If intussusception is encountered, contrast will be kept on continuously for three (3) minutes with brief intermittent fluoroscopy. This procedure can be repeated a total of three (3) times with drainage into the bag after the first two attempts. After the third attempt, let the child evacuate spontaneously.
  5. An intussusception is reduced when significant reflux into the terminal ileum is seen. Keep in mind that an edematous ileocecal valve appears as a mass that can mimic non-reduction.
  6. Document reduction with one KUB
  7. If reduction has not been successful, but progress has been made and the patient is stable, subsequent attempts can be performed in 2-3 hours.