Management of the child after enema-reduced intussusception: hospital or home?

BACKGROUND

Standard practice has been to admit children for an observation period after enema-reduced intussusception. However, the utility of such routine practice has not been clearly justified.

STUDY OBJECTIVES

The main objective was to determine the rate and timing of recurrent intussusception after successful enema reduction and describe any associated complications.

METHODS

The study was a retrospective chart review identifying children with enema-reduced intussusception during a 7-year period from 2002 through 2008. Subjects were children ages 0 to 17 years presenting to the Emergency Department (ED) of a tertiary care, free-standing children's hospital with confirmed and uncomplicated enema-reduced intussusception.

RESULTS

During the study period there were 98 children with successful enema reduction of intussusception. There were 10 episodes of recurrence in 7 patients, for an overall recurrence rate of 7.1%. Three patients had two recurrences each, and the remainder had single recurrences. Two patients had early recurrences (<48 h) at 3 and 5 h, for an early recurrence rate of 2.0%. The late recurrence rate (>48 h) was 5.1%. No adverse events were noted in any of the recurrences.

CONCLUSIONS

Given the low early recurrence rate for enema-reduced intussusception and the minimal risk of adverse outcomes, ED observation for a 6-h period seems to be a safe alternative to inpatient management. These results support previous work and suggest that these patients can be managed on an outpatient basis.