Iatrogenic Perforation During Pneumatic Reduction of Pediatric Intussusception
Iatrogenic Perforation During Pneumatic Reduction of Pediatric Intussusception - Radiology clinical simulation case. A 2-year-old boy with a 36-hour...
Age: 2 • Gender: Male • Setting: Emergency Triage
Clinical Presentation & History
A 2-year-old boy with a 36-hour history of intermittent colicky abdominal pain, intermittent drawing up of the legs, vomiting, and currant-jelly stool. Ultrasound confirmed ileocolic intussusception and the child was taken to fluoroscopy for pneumatic (air) enema reduction. During insufflation under fluoroscopy, free intraperitoneal air suddenly becomes visible across the abdomen.
Acute Resuscitation Milestones & Priorities
Clinical phases and key interventions encountered in this emergency module:
Fluoroscopic Recognition of Free Air
Tension Pneumoperitoneum and Respiratory Compromise
Fluid Resuscitation, Antibiotics, and Resuscitative Laparotomy Prep
Informed Consent, Family Communication, and Operating Room Handoff
High-Yield Clinical Pearls
Pneumatic enema reduction of pediatric intussusception carries a perforation risk of approximately 1%; pre-procedural disclosure of this risk is mandatory and the family should be informed before consenting.
Free intraperitoneal air under fluoroscopy is pathognomonic for iatrogenic perforation; the procedure must be terminated at once and surgical consultation activated, never modified to a different technique.
Tension pneumoperitoneum in a toddler causes diaphragmatic splinting and obstructive shock; needle decompression of the left lower quadrant restores ventilation before airway management.
Pediatric enteric perforation requires empiric broad-spectrum coverage (e.g., piperacillin-tazobactam) prior to incision and 20 mL/kg isotolic crystalloid bolus for third-space losses.
Informed consent in a non-native-speaking guardian must use a qualified interpreter; disclosure of iatrogenic injury should be factual, non-pejorative, and include the recognized risk statistics.
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