PEDIATRICS
EXAM
■ Variable physical exam, ranging from well-appearing and asymptomatic to
toxic and lethargic
■ “Dance’s sign,” which is reduced bowel gas in the RLQ may be appreci-
ated (see Figure 5.18).DIAGNOSIS
■ AXR: Reduced bowel gas in the RLQ (radiographic “Dance’s sign”)
■ Ultrasound is noninvasive and easily obtained.
■ Contrast enema: May be therapeutic as well as diagnostic. The traditional
teaching is for the surgeon to be present in the radiology suite when the
enema is administered in case surgical intervention is required. Barium
enemas are contraindicated if there is evidence of perforation or peritoni-
tis; air- or water-soluble contrast may be used. Enemas may successfully
reduce intussusception for 70–95% of patients. Air-contrast enema has
become the method of choice because of the reduced risk of complica-
tions and higher success rate.TREATMENT
■ NG tube, IV fluids if dehydrated, NPO, and IV antibiotics
■ Air contrast enema
■ Surgical intervention is indicated if the contrast enema fails to reduce the
intussusception or if intussusception recurs.FIGURE 5.18. Intussusception (Dance’s sign).(Reproduced, with permission, from Shah BR, Lucchesi M. Atlas of Pediatric Emergency
Medicine. New York: McGraw-Hill, 2006:431.)