Purpose or Case Report: Determine if the length of time between diagnosis of an intussusception and therapeutic enema, or reported length of symptoms, is associated with lower enema success rates or higher rates of complicated surgery and bowel resection.



Methods & Materials: An IRB approved, retrospective study was performed. The radiology information system at our institution was queried for the keyword “intussusception” in fluoroscopic reports from September 2012 – August 2017. The length of time (“time to catheter”) between diagnosis of intussusception, defined as the end time stamp of the ultrasound or CT on which it was first identified, and the start of therapeutic enema, defined as the first time stamp on images from the enema, was then calculated. In addition, the medical record was reviewed for overall length of symptoms (LOS) as documented in the emergency department note. Correlation with enema results, and surgical outcomes in patients failing reduction, was then performed. Complicated surgical cases were defined as those that required more extensive surgery than a standard laparoscopic reduction, such as conversion to open laparotomy.
Results: 209 cases were reviewed. There were 148 successful enemas and 61 failures. No significant difference was found in mean overall LOS between the 2 groups (1.44 days vs 1.58 days, p = 0.44) or in mean “time to catheter” (1 hour 53 minutes vs 1 hour 54 minutes, p = 0.3). Using grouped analysis, in patients with “time to catheter” of 0 – 4 hours versus those > 4 hours, no significant difference was identified in enema success rates (71% vs 65%, p = 0.6), rates of complicated surgery (11% vs 12%, p = 0.9), or rates of bowel resection (8% vs 12%, p = 0.56). Similarly, there was no significant difference among groups with the shortest and longest LOS. In patients with LOS 0 – 1 days versus those > 2 days, enema success rates (73% vs 68%, p = 0.5), complicated surgery rates (9% vs 15%, p = 0.25), and bowel resection rates (6% vs 13%, p = 0.14) were not significantly different.

Conclusions: Air enemas for intussusception performed within 4 hours of diagnosis did not show a difference in rates of enema success, complicated surgery, or bowel resection compared to those performed greater than 4 hours after diagnosis. Additionally, overall length of symptoms does not show a difference in rates.