Intussusception reduction is a procedure performed in paediatric patients who have an ileocolic intussusception.
There are several ways that reduction can be achieved radiologically:
- physical reduction under US guidance
In air-reduction and water-reduction methods, a catheter is inserted into the rectum of the child and under fluoroscopic guidance, air or water is instilled into the large bowel.
The main risk of reduction is perforation, but since without radiological reduction, an operation is required, this risk is worth taking.
Assessment with ultrasound prior to the reduction allows stratified risk assessment. Intussusception with reduced vascularity or interloop fluid is usually more challenging to reduce.
With air-reduction, pressures in the region of 60-100 mmHg, it is possible to reduce the intussusception back to the ileocolic valve. There are a variety of protocols that have been suggested with some advocating 3 attempts lasting 3 minutes.
The most likely portion of the bowel to perforate is the rectum so it is important to monitor the diameter of the rectum during the procedure rather than just concentrating on the position of the intussusception.