PubMed · 7380162
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R H Marshak. 1980-04-30. Enteroclysis.. https://doi.org/10.1007/bf01888626
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Perforation during attempted gas-enema reduction of intussusception is more common than during a barium enema. In a review of 650 consecutive attempted gas enemas, perforation occurred in 7 infants (1.1%). Gross abdominal distension from the pneumoperitoneum may be rapid and cause splinting of the diaphragm, which leads to acute respiratory distress. This complication is readily recognised at the time of the gas enema, and may require immediate intervention by paracentesis using a 14-gauge needle. A review of 7 children with intussusception in whom perforation occurred revealed that all had radiologic evidence of bowel obstruction (air-fluid levels) prior to the enema, and the patients had had a relatively long history since the onset of symptoms. No perforation occurred during a delayed repeat enema reduction. Perforation during gas enema produces minimal peritoneal contamination. No pathological lesion at the lead point of the intussusception was identified in any of the children in whom perforation occurred.
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We report the case of a 10-month-old boy with intussusception. Following two failed air enemas, successful reduction of his ileocolic intussusception was achieved laparoscopically. We do not advocate abandoning safe and established surgical techniques used to treat irreducible lesions, but we are encouraged by this experience to further explore the role of laparoscopy in the treatment of this common condition.