Air enema for intussusception: is predicting the outcome important?

Air enema is the treatment of choice for childhood intussusceptions. Although peritonitis is the established contraindication, studies have attempted to identify factors that affect the outcome of air enema. In our series we studied the impact of such factors on the clinical scenario to determine if it was important to predict the outcome of air enema. We retrospectively reviewed the records of 179 children who underwent air enema for intussusception at our institution over a 5-year period. Abdominal colic was present in 144 children, vomiting in 139 and rectal bleeding in 108 children. The duration of symptoms was less than 24 h in 131 children. An abdominal mass was present in 121 children, rectal prolapse of intussusception in 14, dehydration in 31 and small bowel obstruction in 27 children. The success rate of air enema was calculated. All clinical features were analyzed for impact on outcome using univariate and multivariate analysis. The extent of this impact on the clinical scenario was examined. Air enema was successful in 157 cases (89%). One child developed a perforation during the procedure (0.6%). The recurrence rate was 8%. Using chi2 test, success of air enema was reduced in the presence of rectal bleeding, rectal prolapse of intussusception, dehydration, and small bowel obstruction. This reduction was statistically significant (P < 0.05). Using logistic regression analysis, the success of air enema was significantly reduced (P < 0.05) only in the presence of prolapsing rectal intussusception (57%) and small bowel obstruction (52%). Small bowel obstruction and prolapsing rectal intussusceptions merely reduce the success of air enema and do not increase the complications. Since the success of air enema is very high, it must be attempted in all children with the exception of peritonitis. Predicting the outcome is not crucial because of the high success rate and low complication rate.

Rectal prolapse of intussusception--a single institution's experience.

AIM: The objective was to study the clinical presentation and outcome of intussusceptions prolapsing rectally. METHODS: A retrospective analysis was done of 198 children who presented with intussusception at a single institution over a 5-year period. Of this group, the data of children with intussusception prolapsing rectally was studied. RESULTS: The incidence of prolapsing intussusception in this series was 8%. All 16 patients were infants with an average age of 5 months. The most common presenting features were rectal bleeding and abdominal mass. Only 56% of children had abdominal pain. 4/16 children had abdominal distension and 4 had dehydration. The duration of symptoms was less than 48 hours in 14/16 patients. Air enema reduction (AER) was attempted in 14/16 patients and was successful in 8 patients. The success rate of AER was 57%. One patient developed a perforation during AER. Manual reduction was done in six patients who failed AER and in two patients in whom AER was not attempted because of prolonged duration of symptoms (> 48 hrs). There were no recurrences in this series. CONCLUSION: The incidence of intussusceptions prolapsing rectally is high in this series. It can present in the absence of the cardinal symptoms of intussusception. A high index of clinical suspicion is necessary to make the diagnosis. AER is often successful and must be attempted in children who do not have contraindications for this procedure.

Protective effect of N-acetylcysteine against gamma ray induced damages in rats--biochemical evaluations.

The effect of N-acetylcysteine (NAC) (Ig/kg body weight in saline for 7 days) against the damages induced by gamma ray was studied. Whole body exposure of rats to gamma-rays (3.5 Gy) caused increases in lipid peroxides (P < 0.01). Reduced glutathione (GSH) (P < 0.01) and total sulphydryl groups (TSH) (P < 0.05), were found to be increased probably to counteract the damages produced by the lipid peroxides. The plasma antioxidant vitamins E, C and A were reduced. The activities of antioxidant enzymes, superoxide dismutase (SOD), catalase and glutathione peroxidase (GPx) were enhanced, which might be to eliminate the superoxide radical and H2O2 and accompanied by a fall in glutathione-s-transferase (GST) and glutathione reductase (GR) activity. The excessive production of free radicals and lipid peroxides might have caused the leakage of cytosolic enzymes such as aminotransferases (AST and ALT), lactate dehydrogenase (LDH), creatine kinase (CK) and phosphatases. Membrane damage is quite evident from histological studies undertaken in the intestinal tissue, which is susceptible to radiation damage. Intragastric pretreatment of NAC (1g/kg body weight in saline for 7 days) prevented the radiation induced damage to an appreciable extent. From the results it may be concluded that NAC is effective in protecting from the damages caused by gamma-ray radiations and its prospects as an adjuvant to radiotherapy should be considered.