Hydrostatic reduction of intussusceptions caused by lead points

It is generally accepted that an intussusception caused by a lead point will not be reduced by hydrostatic barium enema. This was reported several years ago, and has continued to be a consistent finding, prompting us to attempt hydrostatic barium enema reductions of recurrent intussusceptions in infants and children and also in older children with a first intussusception. However, in the last 9 years we have treated five children whose ileocolic intussusception were caused by lead points but which were reduced by hydrostatic barium enema. The histories and physical examinations were not any different than those of the average pediatric patient with an intussusception. The ileocolic intussusceptions diagnosed by barium enema were reduced with adequate reflux of barium into the terminal ileum. However, a residual and persistent filling defect in the colon or ileocecal area made laparotomy mandatory. In all five cases, a lead point was found and resected. This experience has suggested to us that a residual intraluminal filling defect in the barium column following what appears to be adequate flooding of the terminal ileum should be interpreted as a lead point, and an indication for a laparotomy.