Chapter 2333: [2333] Weighing the Gains and Losses
The air enema procedure for reducing intussusception is relatively safe and is widely used in clinical practice due to its maturity as a technique, but it does impose a time constraint on the patient’s condition. It’s like a myocardial infarction needing urgent treatment within a certain number of hours; otherwise, the effectiveness is greatly reduced or even null.
Specifically, clinical cases have been statistically analyzed. The data shows that this method is most successful when used within 24 hours of the onset in children, with a success rate of over 90 percent. Beyond 24 hours, there is some effect within 48 hours. After 48 hours, the intussusception site is close to necrosis, and using air at this point is basically ineffective, necessitating surgery. Therefore, Xie Wanying emphasized the need to seize the last window period within 48 hours.
The problem is that your timing is approaching 48 hours, the likelihood of intestinal necrosis is high, and the success rate for an air enema is low. Trying to do this on the child is a major gamble.
It’s not that air enemas are entirely without risk. The most dangerous aspect of an air enema is, as you might expect, similar to inflating a rubber device; if it doesn’t inflate, you can only increase the gas pressure, and with increased pressure, there’s a possibility of the tube bursting within the intestinal cavity. A necrotic section of intestine is difficult to inflate, making the risk of bursting greater. Within the human body, an intestinal burst results in a perforation and massive bleeding in the abdominal cavity.
Okay, the doctor knows about this terrifying complication and tries to lower the pressure as much as possible. Yet there’s still a tricky complication waiting for you, namely, further intussusception.
Most laypeople would find this incredible: how could using this method meant to solve intussusception cause more intussusception?
The intestines are far more complex than rubber tubes. A rubber tube has only one layer and is flat, whereas intestines are not.
According to the anatomical subfield of histology, the structure of the gut can be divided into mucosal layer, muscular layer, and serosa. The most complex mucosal layer features circular fold structures, which are simply called wrinkles, and this is a normal physiological phenomenon.
The intestinal mucosal folds evolved naturally as a physiological structure to extend the time food stays in the intestines so that they can effectively absorb the nutrients from the food.
Imagine, if food slipped through a smooth rubber tube, it would pass through the intestines too quickly, making it difficult for the body to absorb nutrients and even water.
In clinical exams of the digestive tract, if you pay attention to some inspection reports, you’ll find descriptions of the intestinal folds by doctors. If the circular folds have issues, it indicates a partial cause for the patient’s indigestion.
Given that intestines have these unique physiological structures, when air is introduced into the intestine, and if it can’t push back the inserted intestine, it may lead to functional disorders in other segments, resulting in additional intussusception elsewhere. Essentially, the plentiful folds of the intestine are another potential factor for intussusception.
In summary, as long as the likelihood of intestinal necrosis is high and the air pushes don’t work, it’ll cause lots of complications, let alone curing the condition. The chances of intestinal necrosis are directly proportional to the duration of the child’s illness.
From this perspective, the success rate of using an air enema on this child isn’t very high. The doctor’s focus must remain on possible complications. Without being a specialized pediatric surgeon, with limited case experience, and lacking confidence to handle issues that may arise during treatment, there is no choice but to abandon the procedure.
Not performing it is safer than risking the child’s life. If complications arise, it might be considered a medical malpractice. No doctor dares to take such a risk.