Hydrostatic enema

The preferred reduction technique is either that of the air enema under fluoroscopic guidance or of air or hydrostatic enema under ultrasound guidance. The only absolute contra-indication to attempted enema reduction is full thickness bowel necrosis (which will present with features of shock and peritonitis) or if there is imaging evidence of perforation with free air. 

After a barium enema, perforation occurs rarely in children and debilitated adults or when the colon is already weakened by inflammatory, malignant, or parasitic diseases. Perforation can be triggered by manipulations involved in giving the barium enema or can result from hydrostatic pressure. In one case, perforation followed air contrast insufflation for barium enema in a patient in whom the sigmoid colon became trapped in an inguinal hernia. 

Zambuto D, Bramson RT, Blickman JG (1995) Intracolonic pressure measurements during hydrostatic and air contrast barium enema studies in children. Radiology 196 55-58... 

In the dark lumen technique the colon is filled with 2,000-2,500 ml of warm tap water using hydrostatic pressure after placement of a rectal enema tube or a... 

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