Management of childhood intussusception after reduction by enema

Objective: The objective of the study was to describe the utility of emergency department (ED)/outpatient management after enema reduction for childhood intussusception. Methods: A retrospective medical record review of children aged 2 months to 6 years with confirmed intussusception who underwent enema reduction in a tertiary care academic children's hospital was performed. Subjects were analyzed with respect to location of care after reduction (ED/outpatient vs inpatient) and number, timing, and outcome of recurrences. Results: One hundred seventeen patients were diagnosed with intussusception by contrast or air enema during the 15-year study period, and 56 fulfilled our inclusion criteria. Ten patients (18%) were admitted to hospital after enema reduction. Mean length of stay was 33.7 hours in the hospitalized group and 7 hours in the ED group. Seven of the 56 patients had recurrences (12.5% recurrence rate). Two recurred while being observed in the ED (at 30 minutes and at 2 hours after reduction), 2 recurred at home (at 10 and 28 hours after reduction), and the other 3 recurred several months later. The early recurrence rate (recurring within 24 hours) was 5.3%. No patient had an adverse event (perforation, sepsis, bowel resection). Conclusions: Outpatient management is used for the majority of patients with intussusception at our institution after enema reduction. The early recurrence rate is low, and patients with recurrence after discharge do well without adverse outcomes. Emergency department observation of patients after enema reduction appears to be safe and should be routine for uncomplicated cases of intussusception. (C) 2011 Elsevier Inc. All rights reserved.