What are the non-operative methods of management for intussusception in a 32-year-old male?

Non-operative Management of Intussusception in a 32-Year-Old Male

For adult intussusception, air enema reduction (option C) is the preferred non-operative management approach when the patient is hemodynamically stable, without signs of peritonitis, bowel ischemia, or perforation. 1

Assessment of Suitability for Non-operative Management

Before attempting non-operative reduction, careful patient selection is critical:

• Evaluate for signs of peritonitis, strangulation, or bowel ischemia which would necessitate immediate surgical intervention 2
• Confirm diagnosis with CT scan, which is more sensitive than plain radiographs for detecting complications 2
• Consider duration of symptoms - success rates are higher when symptoms have been present for less than 24 hours 3
• Assess hemodynamic stability - non-operative management should only be attempted in stable patients 2

Non-operative Management Options

Air Enema Reduction (Recommended First-line)

• Air enema under fluoroscopic guidance offers several advantages over other methods:
  • Lower risk of perforation compared to hydrostatic techniques 1
  • Better control of intraluminal pressure with continuous monitoring 1
  • Higher success rates reported in case studies of adult patients 1
• Technique:
  • Patient should receive oxygen and potentially mild sedation for comfort 1
  • Air pressure should be carefully monitored (typically maintained between 40-60 mmHg) 1
  • Successful reduction is confirmed when air reaches the terminal ileum 1, 4

Hydrostatic (Water/Barium) Enema

• Less preferred in adults compared to air enema due to:
  • Higher risk of peritoneal contamination if perforation occurs 5
  • More difficult to control pressure precisely 3
  • Lower success rates in adult populations 6

Colonoscopic Reduction

• May be considered in selected cases where:
  • The intussusception is located in the colon 2
  • Endoscopic expertise is readily available 2
  • Patient is stable without signs of bowel compromise 2
• Note: Endoscopic reduction is associated with higher recurrence rates 2

Monitoring During and After Reduction

• Continuous vital sign monitoring throughout the procedure 1
• Immediate cessation if signs of increasing pain or hemodynamic instability develop 1
• Post-procedure imaging (ultrasound or CT) to confirm complete reduction 1
• Close clinical monitoring for at least 24 hours after successful reduction 2

Important Considerations and Pitfalls

• Adult intussusception differs significantly from pediatric cases:
  • In adults, 70-90% of cases have an identifiable lead point (often neoplastic) 6
  • Higher risk of malignancy, especially in ileocolic and colonic intussusception 6
• Surgical consultation should be obtained in all cases, even when attempting non-operative management 2
• If non-operative reduction is unsuccessful or only partially successful, do not delay surgical intervention 2
• Consider a second attempt at reduction only if there was significant movement of the intussusceptum during the first attempt 3
• Surgical exploration is recommended if:
  • Signs of peritonitis develop 2
  • Patient becomes hemodynamically unstable 2
  • No progression is seen during reduction attempts 3
  • Symptoms persist despite radiographic evidence of reduction 4

Non-operative management should be attempted only in carefully selected adult patients, with immediate surgical backup available if needed.