A 9-month-old infant presents with sudden onset of paroxysmal crying, drawing up of knees, and current jelly stools. Abdominal ultrasound shows a target sign (donut sign) in the right lower abdomen. What is the initial treatment of choice for this stable, hemodynamically normal child?
- A Pneumatic (air) enema reduction under fluoroscopic or ultrasound guidance ✓
- B Emergency surgical reduction (open or laparoscopic)
- C Hydrostatic (saline) enema with warm saline and gravity pressure
- D Watchful waiting for spontaneous reduction with IV fluids
Explanation
Pneumatic (air) enema reduction is the current first-line treatment for ileocolic intussusception in hemodynamically stable children. It has a success rate of 80–95% and is preferred over hydrostatic saline enema because it is faster, cleaner, and requires less radiation exposure. It is performed under fluoroscopic or ultrasound guidance with air insufflation per rectum while monitoring pressure. Contraindications include signs of peritonitis, perforation, or cardiovascular instability — in which case emergency surgery is required. Spontaneous reduction occurs in <10% of cases and watching is inappropriate for a symptomatic child.
Reference: Ghai Essential Pediatrics, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.