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Treatment

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The treatment of choice is reduction by barium enema under radiological control. The enema is simultaneously a method of imaging and of treatment. Hydrostatic reduction with oxygen has been used in some centres. About 10% recur if they are reduced in this way.

Note that a barium enema is contraindicated if there are features of perforation or generalised peritonitis. A relative contraindication is the length of the history - more than 24 hours may be too long.

Surgical indications include:

  • child under 3 months or over 2 years
  • clinical signs of peritonitis
  • gross dehydration
  • failure of medical treatment, or recurrence after medical treatment

Surgical reduction has a recurrence rate of about 3%, resection is said to remove the risk of recurrence.


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