Paediatric Imaging

Air reduction of intussusception

also known as pneumatic reduction. Developed in China, the technique involves introduction of air, usually O2, under pressure via a rectal Foley catheter with as tight a seal as possible around it to prevent gas leak, to raise the intracolonic pressure in an attempt to reduce the intussusception. The maximum delivered pressure should be 120 mmHg. There should be a control valve in the delivery system. The child is examined in the prone position. Advantages compared with hydrostatic reduction are that it is quicker and cleaner. Disadvantages are few except that if a perforation occurs a large pneumoperitoneum may occur, embarrassing respiration. A trochar inserted into the peritoneal cavity soon relieves the situation. Success rates are quoted as between 70 and 80% in nonselected cases. Successful reduction is identified when air is seen to enter the small bowel through the ileocaecal valve. This may remain as a filling defect in the caecum due to oedema and should not be mistaken for residual intussusception. See intussusception

HC