A 3-year-old child is brought to casualty with a 2-hour history of sudden-onset colicky abdominal pain, drawing up of legs, and a jelly-like 'red currant jelly' stool. Abdominal ultrasound shows a 'target sign' (pseudokidney sign) in the right flank. Ileocolic intussusception is confirmed. Which is the recommended first-line treatment in a hemodynamically stable child without perforation?
- A Pneumatic (air) or hydrostatic (saline) enema reduction under fluoroscopic or ultrasound guidance ✓
- B Emergency laparotomy and manual reduction
- C IV antibiotics and NG drainage for 24 hours before reduction
- D CT-guided drainage of the intussusception
Explanation
Pneumatic enema (air insufflation) or hydrostatic enema (saline/water-soluble contrast) reduction under fluoroscopic or ultrasound guidance is the first-line treatment for ileocolic intussusception in stable children without signs of perforation, peritonitis, or bowel necrosis. Success rates are 80–90% with air enema. Absolute contraindications include peritonitis, perforation (free air), and hemodynamic instability. Failure of non-operative reduction or the above contraindications mandate surgical exploration. Three enema attempts are generally allowed before proceeding to surgery. Lead points (Meckel's, polyp, lymphoma) should be suspected in older children (> 2 years) or recurrent cases.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.