Intussusception is the invagination of a segment of bowel into the distal adjacent bowel. Commonly it involves distal ileum and proximal colon and no lead point identified. It is a common cause of bowel obstruction in a less than two year of age [1]. Neonatal per rectal bleeding and intussusception is rare and comprises of 0.3% of all cases of childhood intussusception (2–4). Often vomiting and blood in the stool are the commonest symptoms. The incidence of intussusception in UK is about 1.6-4 cases per 1000 live birth. It is slightly commoner in boys than girls with ratio of 3:2 (5).

Abdominal pain and palpable abdominal mass are uncommon features in neonate, however if these are present, the diagnosis of intussusception can be made confidently [2]. Classical triad often described that patient will have colicky abdominal pain, vomiting and bloody stool [2,5]. However, in this case, since the patient is only 48 hours of life, only signs can be elicited. The most common intussusception at ileocolic, accounting about 80% of cases. Others are colocolic, rare for small bowel (ileoileal) intussusceptions [3,5]. Only about 2-12% of lead point can be identified in intussusception, but most neonates and infant do not have identifiable lead point [5].

Plain abdominal radiograph may show bowel dilatation if there is evidence of intestinal obstruction, but this is inconclusive. In United Kingdom, universally abdominal ultrasonography (USG) is the investigation of choice. It has sensitivity of 98% and specificity of 100% when looking for features of intussusception. The signs that suggestive evidence of intussusception are target and pseudokidney sign [1,5]. In our case, it was proven by USG image presence of those signs. 

For this case, once diagnosis is established, fluid resuscitation was administered and antibiotics started for presumed sepsis. We arranged for barium study however intussusception spontaneously reduced upon investigation done. Therefore, the baby was managed conservatively. Non-operative management consist of saline, air or barium reduction. This procedure is performed by experienced radiologist under USG or fluoroscopy guidance. The success of procedure is determined by saline or contrast flow into proximal ileum. The contraindication for this procedure if patient has peritonitis or in shock. Saline or barium reduction success rate is about 70-80% of cases [1,5]. Presence of peritonism, perforation and failure of hydrostatic reductionare the indication for laparotomy. Open laparotomy and open reduction is the definitive management.