A 9-month-old boy presents with two episodes of vomiting as well as episodes of colicky pain. His abdominal examination is notable for upper abdominal tenderness, and his stools are guaiac-positive. US demonstrates a target sign, and he is then taken for an air-contrast enema. What is the likelihood that he will need operative intervention?
A. 25%Patients with intussusception should be assessed for the presence of peritonitis and for the severity of systemic illness. In the absence of peritonitis, the child should undergo radiographic reduction. The air enema is diagnostic and may also be curative, and it is the preferred method of diagnosis and treatment of intussusception. Air is introduced with a manometer, and the pressure that is administered is carefully monitored. Under most instances, this should not exceed 120 mm Hg. Successful reduction is marked by free reflux of air into multiple loops of small bowel and symptomatic improvement as the infant suddenly becomes pain-free. Unless both of these signs are observed, it cannot be assumed that the intussusception is reduced. If reduction is unsuccessful and the infant remains stable, the infant should be brought back to the radiology suite for a repeat attempt at reduction after a few hours. This strategy has improved the success rate of nonoperative reduction in many centers. In addition, hydrostatic reduction with barium may be useful if pneumatic reduction is unsuccessful. The overall success rate of radiographic reduction varies based on the experience of the center and is typically between 60 and 90%.