Air Enema for Acute Intussusception Management

First-Line Treatment Approach

• For acute intestinal obstruction due to intussusception in hemodynamically stable patients without signs of peritonitis or bowel ischemia, air enema reduction should be attempted first before proceeding to surgery. 1

Contraindications to Non-Operative Management

• Signs of peritonitis (guarding, rigidity, rebound tenderness) mandate immediate surgery. 1, 2
• Hemodynamic instability despite resuscitation requires emergency surgical exploration. 1, 2
• Radiological evidence of perforation (pneumoperitoneum) is an absolute surgical indication. 2
• Clinical signs of bowel ischemia (markedly elevated lactate, severe continuous pain, bloody stools) necessitate immediate operation. 2

Timing and Follow-Up

• Delay beyond 48 hours significantly increases mortality, so air enema should be attempted promptly after diagnosis. 1
• If air enema fails, surgical exploration should proceed without further delay. 1
• Patients require close monitoring for at least 24 hours after successful reduction to detect early recurrence. 1

Alternative Modalities

• No evidence supports steroid enema for acute intussusception treatment. 1, 2
• Endoscopy is not indicated for ileocolic intussusception. 1
• Endoscopic reduction carries a high recurrence risk and is not standard practice for typical intussusception. 1
• Endoscopy is only recommended for proximal small bowel obstruction after bariatric surgery or when bezoar is suspected in the stomach. 3, 4

Special Populations

• In adults, 90% of intussusception cases have an underlying pathological lead point (often malignancy), making surgical exploration more commonly indicated. 1
• Adult intussusception typically requires surgery for both diagnosis and treatment of the underlying cause. 1