An 8-month-old infant presents with intermittent colicky pain and palpable right upper quadrant mass. Ultrasound shows a target or doughnut sign. Air enema reduction is attempted. Which of the following is a contraindication to pneumatic (air) enema reduction of intussusception?
- A Duration of symptoms > 24 hours
- B Ileocolic intussusception confirmed on ultrasound
- C Peritoneal signs or evidence of perforation ✓
- D Age less than 3 months
Correct answer: C. Peritoneal signs or evidence of perforation
Explanation
Peritoneal signs (tenderness, guarding, rigidity) or free air on imaging indicating perforation are absolute contraindications to pneumatic or hydrostatic enema reduction, as increasing intraluminal pressure in a perforated bowel risks peritoneal contamination and tension pneumoperitoneum. Duration > 24 hours and age < 3 months increase the risk of failed reduction and complications but are relative, not absolute, contraindications. Ileocolic type is the target for reduction, not a contraindication.
Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.
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