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during the procedure. Air enemas can lead to massive pneumoperitoneum and
cardiopulmonary arrest unless the abdomen is rapidly decompressed (by needle
decompression). Children are not typically sedated for enema reductions,
although there is weak evidence to suggest that sedation may lead to a higher
success rate. Delay in reduction can lead to gangrenous bowel.
Children who have undergone successful air enema reduction, who are
subsequently well-appearing and tolerate oral intake may be candidates for
discharge home from the emergency department with close outpatient
observation. Caregivers must be educated about the risk of recurrence, which
ranges from 3% to 5% in the first 48 hours. When there is a recurrence, a second
attempt at reduction may be done by enema. This is successful in most cases, but
with a third episode of intussusception, an exploratory laparotomy should be
considered. Recurrences are more common in older children and may be caused
by a lead point such as a Meckel diverticulum, an intestinal polyp, or an
intraluminal tumor such as lymphoma. Therefore, it may be wise in an older child
to perform cross-sectional imaging or to operate with the first recurrence.

Incarcerated Inguinal Hernia
Goals of Treatment
The goal of treatment of an incarcerated inguinal hernia is to perform a reduction
before the hernia becomes strangulated. Early surgical consultation is necessary
in cases of incarceration with evidence of bowel obstruction or ischemia.
CLINICAL PEARLS AND PITFALLS
Inguinal mass may represent a torsed ovary or testicle
Blood per rectum with an inguinal hernia may be an indicator of
gangrenous bowel
Bowel obstruction or concerns for ischemic bowel should prompt
emergent surgical consultation
Procedural sedation may be necessary to facilitate reduction of a
hernia
Current Evidence

Incarcerated inguinal hernia is a common cause of intestinal obstruction in the
infant and young child. Approximately 60% of incarcerated hernias occur during
the first year of life. Incarceration occurs more often in girls than in boys, but