A Clinical Observation of Intussusception in Infants and Children: Comparing the results of barium enema with that of controlled air insufflation

Kim, Nam Heon; Park, Won A; Kim, In Ho; Chung, Churl Young; Kim, Sang Woo

Abstract

Intussusception which is the mot frequent cause of intestinal obstrucsion in childhood, is the invagination of a segment of the gastrointestinal tract into an adjacent segment. Since 1927, barium enema under fluoscopic guidance has been used widely as a therapeutic method. In 1953, Fiorito and Cuestas reported the use of controlled insufflation of air for diagnosis and treatment of intussusception. This method has several advantages than barium enema for diagnosis and treatment, with its simplisity, fast diffusion of air, clear-cut visualization of intussusception, no contraindications, and no interference with the normal physiology of bowel. We compared the results of treatment with barium enema in 117 cases with that of controlled air insu-fflation in 50 cases from January, 1976 to Octover, 1981. The results were summarized as follows 1) Age and sex distribution of the overall cases: 82% of the patients were under 1 year of age(the peak incidence was 4~8 months of age) with the predominence of male(2.2:1). 2) Growth percentile comparing with Korean standard data: 67% of the patient were above 50 porcentile. 3) Seasonal incidence: slight prevalence was noted during spring, but not significant. 4) Etiologic factors: 97% of the patient were idiopathic and only 3% of the cases had organic causes. 5) Cardinal symptoms and signs: abdominal pain and irritability 82%, vomiting 76%, bloody mucous stool 64%, and abdominal mass 50.3%. 6) The most common type of intussusception is ileo-colic. 7) Reduction rate: 68.4% for barium enema and 92% for controlled air insufflation(p<0.01). 8) Recurrence rate: 12.5% for barium enema and 8% for controlled air insufflation. 9) Recurrence interval of overall cases is the most frequently from one month to 6 months after reduction. 10) Perforation: One case with barium enema and 2 cases with controlled air insufflation. 11) Duration and pressure requiring to reduce by controlled air insufflation: 84.8% of cases reduced within 30 min. and the pressure required to reduce was about 61 mmHg to 100 mmHg in 73.9% of cases.