A 2-year-old girl presents with colicky abdominal pain, vomiting, currant jelly stools, and a sausage-shaped mass in the right iliac fossa. Ultrasound shows a target/pseudokidney sign. What is the correct first-line management?

• A Emergency laparotomy and manual reduction of intussusception
• B IV atropine and observation for spontaneous resolution
• C Pneumatic (air) or hydrostatic (saline/barium) enema reduction under radiological guidance ✓
• D Conservative management with nasogastric decompression and IV fluids only

Explanation

Ileocolic intussusception in a hemodynamically stable child without peritonitis is managed by pneumatic air enema reduction under fluoroscopic or ultrasound guidance, with success rates of 70-90%. Contraindications to non-operative reduction include peritonitis, perforation, or hemodynamic instability. Recurrence rate after enema reduction is approximately 5-10%. Surgical reduction (or resection if bowel ischemia) is reserved for failed enema reduction or peritonitis. In children over 2 years, a lead point (Meckel's diverticulum, polyp, lymphoma) should be suspected and may necessitate surgery.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.