Therapeutic enema, contrast or air, for reduction of intussusception or other intraluminal obstruction (eg, meconium ileus)
CPT4 code
Name of the Procedure:
Therapeutic Enema, Contrast or Air for Reduction of Intussusception or Other Intraluminal Obstruction
(Commonly referred to as Contrast Enema, Air Enema, or Therapeutic Enema)
Summary
A therapeutic enema involves the use of a contrast material or air injected into the rectum to help relieve blockages in the intestines, such as intussusception or meconium ileus. The procedure leverages the pressure created by the injected material to alleviate the obstruction and restore normal bowel function.
Purpose
This procedure addresses conditions like intussusception (where part of the intestine slides into an adjacent part) and other forms of intraluminal obstruction, such as meconium ileus. The primary goal is to non-surgically reduce the obstruction, relieve symptoms, and ensure the proper passage of intestinal contents.
Indications
- Acute abdominal pain and symptoms indicative of bowel obstruction.
- Intussusception in infants and young children.
- Meconium ileus commonly observed in newborns with cystic fibrosis.
- Confirmation from diagnostic imaging (e.g., ultrasound, X-ray) showing evidence of intestinal obstruction.
Preparation
- Patients, especially infants, may need to fast (no solid food or liquids) for several hours before the procedure.
- Pre-procedural assessments such as a physical exam and diagnostic imaging (ultrasound or X-ray) to confirm the obstruction.
- Discuss any current medications with the healthcare provider to determine if any adjustments are needed.
Procedure Description
- The patient is positioned on an X-ray table.
- A lubricated catheter is gently inserted into the rectum.
- Contrast material or air is slowly introduced through the catheter into the rectum and colon.
- Real-time X-ray imaging monitors the movement of the contrast or air, revealing the location of the obstruction and helping to guide reduction.
- Pressure created by the enema helps to unfold the intussuscepted segment of the intestine or move the obstruction.
Duration
The procedure typically takes 30 minutes to an hour.
Setting
The procedure is usually performed in a hospital's radiology department.
Personnel
- Radiologist or pediatric radiologist
- Radiology technician
- Nurses or pediatric nurses
- Pediatrician or gastroenterologist (in some cases)
Risks and Complications
- Perforation of the bowel
- Infection
- Minor discomfort or cramping during the procedure
- Rarely, failure to reduce the obstruction, requiring surgical intervention
Benefits
- Non-invasive or minimally invasive treatment
- Immediate relief from obstructive symptoms
- Avoidance of surgical procedures and associated risks
- Quick recovery time
Recovery
- Observation for a few hours post-procedure to ensure no adverse reactions.
- Clear liquids and a gradual return to a normal diet as recommended.
- Follow-up imaging or examination to confirm successful reduction and normal bowel function.
- Instructions on signs of complications to monitor at home.
Alternatives
- Surgical reduction, which might be necessary if the enema is unsuccessful.
- Medication management for less severe or partial obstructions.
- Continued observation in mild cases where spontaneous resolution is possible.
Patient Experience
- The patient may experience some discomfort or cramping during the enema.
- Anesthesia or sedation is generally not required but might be used for comfort in young children.
- Post-procedural discomfort is usually mild and manageable with over-the-counter pain relief under medical advice.