From the Research
The initial treatment for intussusception in a 4-year-old child is air enema reduction, which has a high success rate of approximately 90% as shown in the study by 1. This non-surgical approach serves as both a diagnostic and therapeutic intervention. The procedure involves introducing air into the rectum under radiographic or ultrasound guidance, creating pressure that pushes the invaginated bowel segment back into its normal position. Prior to the procedure, the child should be stabilized with IV fluids to correct any dehydration, and nasogastric tube placement may be necessary to decompress the stomach. Antibiotics are typically not required unless there are signs of perforation or peritonitis. Some key points to consider when performing air enema reduction include:
- The use of a rectal catheter with an inflated balloon may improve the efficacy of the procedure, as shown in the study by 2.
- Ultrasound-guided enema reduction is a safe and effective method, with a success rate of 80% as reported in the study by 3.
- Early discharge after successful reduction is possible, with no significant risk of complications, as demonstrated in the study by 1. If enema reduction fails after 2-3 attempts, or if the patient shows signs of peritoneal irritation, shock, or perforation, immediate surgical intervention becomes necessary. The procedure is contraindicated in patients with signs of peritonitis or bowel perforation, in which case emergency surgery is the first-line treatment. Prompt treatment is essential as delayed intervention increases the risk of bowel ischemia, necrosis, and perforation. It's worth noting that the study by 4 found that predicting the outcome of air enema reduction is not crucial due to the high success rate and low complication rate, and the study by 5 identified predictors of successful air enema reduction in infants younger than 4 months, but these findings may not be directly applicable to a 4-year-old child.