Mechanism of perforation occurring in the intussuscipiens during hydrostatic reduction of intussusception.

Perforation of bowel during attempted hydrostatic reduction of an intussusception almost always occurs through the distal, apparently uninvolved bowel. It is probably never seen except in a group of at-risk children, under 6 months of age. It is not related to unduly high enema pressure, but to involvement of the blood supply in the intussusceptum and obstruction of the blood supply with resulting ischemic changes in the "apparently" uninvolved intussuscipiens. The authors provide support for their suggested mechanism by their findings at operation and in the resected specimens from seven children with an irreducible intussusception and one 5-month-old child whose bowel perforated during attempted hydrostatic reduction. Because children under 6 months of age are susceptible to perforation, hydrostatic reduction of intussuscepted bowel is contraindicated.