Treatment of intussusception with small bowel obstruction: application of decision analysis.

Although hydrostatic reduction of intussusception has been accepted as the most desirable method of treatment, there is still no consensus regarding its application on patients presenting with signs of small bowel obstruction. Decision analysis was used to consider alternative strategies of management, that is, the selective approach of not attempting hydrostatic reduction if there is radiographic evidence of small bowel obstruction, and an attempt at hydrostatic reduction even in the presence of intestinal obstruction, thus operating only when the noninvasive treatment fails. Estimates were based on the experience of one center and an extensive review of the literature. Analysis was performed several times so that the approach resulting in the lowest mortality and morbidity, number of days in the hospital, and monetary costs could be established. Although there is a small risk of perforation with hydrostatic reduction when there is evidence of small bowel obstruction, the attempt is not associated with increased mortality and is overall the best management regarding all other considerations.