DIAGNOSIS AND TREATMENT INTUSSUSCEPTION—A SURGICAL CONDITION
Mark M. Ravitch M.D.1
1 The Section of Pediatric Surgery, The University of Chicago, Department of Surgery
THE gradual increase in the employment of hydrostatic pressure reduction of intussusception with the use of the barium enema has resulted in a gratifying decrease in the number of laparotomies performed. It can also be expected, on the basis of past experience, to result in a decrease of the number of resections required, since some resections have been done on bowel mistakenly thought to be non-viable (and non-viable bowel will not be reduced by hydrostatic pressure properly performed), and in other instances resection has been required for bowel traumatized by the manual reduction itself. The other advantages of hydrostatic pressure reduction are familiar. If the possibility of intussusception is merely entertained, the diagnosis can be made with certainty and the treatment instituted at the same time by barium enema. When immediate operation is the standard treatment for intussusception there may be an understandable tendency to delay operation until the clinical diagnosis has been made unequivocally. Specific lesions causing intussusception, such as polyps, Meckel's diverticula, etc., are not in themselves significant and occur in only 5 or 6% of cases of intussusception. Intussusceptions of long duration may still be totally reducible and, in any case, in practically all of them the intussusceptum is reduced around to the cecum so that if operation is required a right lower quadrant exposure is sufficient and one is spared the necessity of manipulating the bowel around from the left colon to the right colon. Finally, it has been shown in a number of series that, in children who have operative reductions of intussusception, there is a significant incidence of late mechanical intestinal obstruction due to adhesions resulting from the intra-abdominal manipulation.
