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.