ROSH Gastrointestinal Practice Exam

What is a contraindication for using an air-contrast enema in pediatric intussusception reduction?

1. Air contrast enema for a prior episode in the last 24 hours

2. Fever greater than 39°C

3. Lethargy

4. Peritonitis

The correct answer is: Fever greater than 39°C

Using an air-contrast enema in the setting of pediatric intussusception reduction involves some risks, and certain clinical conditions can contraindicate this procedure. A fever greater than 39°C is particularly concerning because it may indicate an underlying infection or inflammatory process that could complicate the enema procedure. This elevated fever can be a sign of sepsis or other serious conditions, which could lead to increased risk of perforation or other complications during reduction attempts. In such cases, alternative methods of management may be required to address the underlying issues before considering a reduction. Other conditions presented, while important to assess, do not pose as direct contraindications to performing the air-contrast enema. For example, lethargy may indicate a systemic issue that requires further evaluation but does not inherently prevent the use of this technique. Similarly, a prior episode within a certain timeframe may warrant caution, but it doesn’t outright prohibit the procedure. Peritonitis is a more complex situation that would typically be associated with surgical intervention rather than just being a contraindication for an air-contrast enema.