FIGURE 116.8 Ileocolic intussusception A: Plain radiographs show an abnormal bowel gas pattern with a soft-tissue mass (asterisk ) in the center of the abdomen B: In transverse US images, echogenic serosa of the intussusceptum is seen inside the lumen of intussuscipiens, giving rise to a “target sign” through the intussusception Color Doppler blood flow is demonstrated within the walls of bowel loops C: Longitudinal image through the intussusception shows a “pseudokidney sign.” A small amount of free peritoneal fluid is seen (Reprinted with permission from Shaffner DH, Nichols DG Rogers Textbook of Pediatric Intensive Care 5th ed Philadelphia, PA: Wolters Kluwer; 2016.) Some children with intussusception require emergency surgery, especially if the intussusception has been of long duration or the child shows evidence of toxic appearance, significant abdominal distension, or gangrenous bowel that might be indicated by peritoneal signs, high fever, leukocytosis, and acidosis If an enema reduction seems safe and appropriate, the operating room should be placed on standby and the operating team should be ready to commence immediate surgery if complications develop during the procedure or if unsuccessful Preoperative preparation and resuscitation begins in the ED and continues during the enema A general surgeon should be present or immediately available in case of perforation