Pain-related distress in children undergoing air enema reduction for ileocolic intussusception: a proof-of-concept case series.

INTRODUCTION

Ileocolic intussusception is a leading cause of acute intestinal obstruction among young children. The standard of care treatment is air enema reduction under fluoroscopic guidance. The pain and distress that might be related to this invasive procedure have not been previously investigated.

OBJECTIVES

We report on pain-related distress observed in 5 children undergoing air enema reduction for ileocolic intussusception.

METHODS

A convenience sample of emergency department patients was assessed using the Face, Legs, Activity, Cry, and Consolability (FLACC) scale conducted at 8 predetermined points throughout the procedure. The staff responsible for the procedure independently recorded their Visual Analog Scale applied by an observer assessment upon procedure completion.

RESULTS

In this sample of children with a median age of 10 months (interquartile range 9-11 months), air enema reduction succeeded on the third attempt in 2 patients, the second attempt in 2 others, and the first attempt in 1 patient. The 4 patients who underwent reduction without sedation or analgesia had first-attempt FLACC scores ranging from 6 to 9, with all maximum scores occurring during air insufflation.

CONCLUSION

Patients experienced considerable pain-related distress during air enema reduction. These preliminary results represent the first report of pain and distress in children undergoing reduction of intussusception and call for a larger-scale study.