Treatment of Intussusception in an 8-Month-Old Infant
For an 8-month-old infant presenting with a sausage-shaped abdominal mass suggestive of intussusception, immediate ultrasound confirmation followed by prompt non-operative hydrostatic or pneumatic enema reduction is the treatment of choice, provided the infant is hemodynamically stable without signs of perforation or peritonitis. 1, 2, 3
Immediate Diagnostic Confirmation
- Ultrasound is the diagnostic modality of choice with 98.1% sensitivity for detecting the characteristic target lesion in pediatric intussusception 1
- Plain abdominal radiographs should be obtained to evaluate for pneumoperitoneum or high-grade bowel obstruction, which would contraindicate non-operative reduction 1, 2
- The classic triad of intermittent abdominal pain, currant jelly stool, and sausage-shaped mass is uncommon; most patients present with intermittent abdominal pain, and younger infants may present atypically with lethargy or altered mental status 2, 4
Treatment Algorithm
Non-Operative Reduction (First-Line Treatment)
Non-operative enema reduction should be attempted immediately in stable patients without contraindications, as this achieves an 82% success rate and avoids surgical morbidity 3
- Either hydrostatic or pneumatic enema reduction can be performed under fluoroscopic or ultrasound guidance 3
- This approach is appropriate for the typical 8-month-old patient, as most cases in the 5-9 month age range are idiopathic without pathologic lead points 1, 4
Contraindications to non-operative reduction include:
- Signs of peritonitis on examination 2, 3
- Evidence of perforation (pneumoperitoneum on radiograph) 2, 3
- Hemodynamic instability 2
- High-grade bowel obstruction 1
Surgical Intervention (When Non-Operative Fails or Contraindicated)
Operative intervention is necessary when:
- Non-operative reduction fails 2, 3
- The patient is unstable or peritonitic 2
- A pathologic lead point is suspected (though uncommon at this age) 2, 4
Surgical exploration allows for manual reduction and resection of any non-viable bowel segments 5
Predictors of Failed Non-Operative Reduction
Be aware that enema reduction is less likely to succeed with:
- Longer symptom duration (>24-48 hours) 3
- Lethargy or fever 3
- Bloody diarrhea 3
- Small bowel obstruction on imaging 3
- Trapped fluid or ascites on ultrasound 3
- Absence of blood flow within the intussusception 3
- Left-sided colonic location 3
Post-Reduction Management
After successful non-operative reduction:
- The infant must tolerate clear fluids and remain asymptomatic before discharge 2
- Close monitoring for at least 24 hours is necessary 5
- Recurrence occurs in 0.1-0.3% of cases, with highest risk in the first 10 days postoperatively 5
- Parents must be counseled to return immediately for any recurrence of symptoms 2
Critical Pitfall to Avoid
Delay in treatment beyond 48 hours significantly increases mortality, making this a true pediatric emergency requiring immediate diagnosis and intervention 5. The 8-month age places this infant in the peak incidence range (5-9 months), where idiopathic intussusception is most common and responds well to non-operative reduction 1, 4.