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