How is intussusception best managed in children?
Intussusception is a medical emergency that occurs in children when a part of the bowel ‘telescopes’ (folds) into another part of the bowel. This causes pain, vomiting, and obstruction, preventing passage. If left untreated, the bowel can perforate, resulting in passage of its contents into the abdominal cavity, causing further complications. In rare cases, these events can cause death. Prompt diagnosis and management reduces associated risks and the need for surgery.
Once intussusception is diagnosed, most doctors agree on the use of enema as initial treatment. This procedure involves introducing a substance (air or liquid) into the bowel, via the rectum, with a particular pressure that reduces the ‘telescoped’ bowel into its normal position.
Debate persists on specifics regarding what type of substance should be used for the enema, how the substance is visualised during the process, whether extra medications should be given to enhance treatment, and how one should deal with treatment failure, as well as the best approach to surgical management of intussusception in children.
Evidence is current to September 2016. We identified six randomised studies, with a total of 822 participants, that explored the management of intussusception in children and assessed different types of interventions. We also identified three ongoing trials.
The main outcome was the number of children with a successfully reduced intussusception. Furthermore, outcomes included the number of children returning with a recurrent intussusception and evaluation of harms (adverse events) resulting from the interventions.
Evidence from two studies suggests that using air for the enema to reduce intussusception is superior to using liquid for the enema. Evidence from two studies also suggests that giving the child with intussusception a steroid medication, such as dexamethasone, may reduce the recurrence of intussusception, irrespective of whether liquid or air is used for the enema.
We identified only sparse information on intraoperative and postoperative complications and on other adverse events.
Quality of the evidence
Of the six trials identified, we considered all to be potentially biased owing to lack of detail in reporting of how each study was undertaken. We found lack of consistency in how outcomes were defined and measured. All included studies were subject to serious concerns of imprecision based on few events, wide confidence intervals,or high risk of bias, Overall, we concluded that the quality of evidence provided by these studies was low, and that the real effects may differ significantly from those noted in these studies.
Further research is needed to help doctors better understand the most effective way to manage intussusception in children.