A 2-year-old girl is brought in with sudden onset colicky abdominal pain, vomiting, and passage of 'redcurrant jelly' stool. Ultrasound shows a 'target sign' in the right iliac fossa. Air enema reduction is attempted but fails. Laparotomy reveals ileo-colic intussusception. Which anatomical point on the ileum is used to determine safe manual reduction versus bowel resection?

• A The junction of the ileum with the hepatic flexure
• B The viable distal ileum can be manually 'milked' backward; resection is required if the leading point cannot be reduced or if bowel is non-viable ✓
• C All ileo-colic intussusceptions require right hemicolectomy
• D Any amount of mucosal congestion mandates resection

Explanation

During operative management of intussusception, the intussusceptum is gently milked (squeezed) in a retrograde direction from the distal end — it should never be pulled. Reduction is safe if the bowel is viable (pink, peristalsing, with pulsatile mesenteric vessels). Resection is required if: (1) manual reduction fails after gentle attempts, (2) bowel is non-viable (black, absent pulsations, full-thickness wall damage), or (3) a clear lead point is identified (Meckel's diverticulum, polyp, duplication cyst) that requires resection. Mucosal congestion alone does not mandate resection if it resolves after reduction. Right hemicolectomy is not performed routinely for ileo-colic intussusception.

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

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Written and medically reviewed by the StethoPrep medical team.