Perforation can occur as a result of bowel-wall ischaemia and necrosis in the intussusception or as a complication of attempted contrast enema (air or contrast reagent) reduction. The rate of perforation at the time of presentation in developed countries is 1% to 3% and usually relates to a delay in diagnosis.[41]Stringer MD, Pablot SM, Brereton RJ. Paediatric intussusception. Br J Surg. 1992 Sep;79(9):867-6.
http://www.ncbi.nlm.nih.gov/pubmed/1422744?tool=bestpractice.com
Approximately 10% of cases of intussusception require bowel resection.[3]Justice FA, Auldist AW, Bines JE. Intussusception: trends in clinical presentation and management. J Gastroenterol Hepatol. 2006 May;21(5):842-6.
http://www.ncbi.nlm.nih.gov/pubmed/16704533?tool=bestpractice.com
[34]Kia KF, Mony VK, Drongowski RA, et al. Laparoscopic vs open surgical approach for intussusception requiring operative intervention. J Pediatr Surg. 2005 Jan;40(1):281-4.
http://www.ncbi.nlm.nih.gov/pubmed/15868598?tool=bestpractice.com
Perforation after attempted contrast enema reduction occurs in 0% to 6% of cases; a figure of approximately 1% is expected for experienced radiologists.[36]Daneman A, Navarro O. Intussusception. Part 2: an update on the evolution of management. Pediatr Radiol. 2004 Feb;34(2):97-108.
http://www.ncbi.nlm.nih.gov/pubmed/14634696?tool=bestpractice.com
These surgical emergencies require prompt surgical evaluation, operative reduction of the intussusception, and resection of threatened non-viable bowel.