A 2-year-old child presents with sudden onset bilious vomiting, severe colicky abdominal pain, and passage of 'redcurrant jelly' stools. On examination, a sausage-shaped mass is palpable in the right iliac fossa. Which of the following is the investigation of choice for both diagnosis AND initial treatment?
- A Plain abdominal X-ray showing crescent sign
- B Barium enema — diagnostic and therapeutic
- C Ultrasound showing 'target sign' or 'pseudokidney sign', followed by pneumatic/hydrostatic enema reduction ✓
- D CT scan with IV contrast — most specific for intussusception
Explanation
Ultrasound abdomen is the investigation of choice for diagnosing intussusception in children, showing characteristic 'target sign' (concentric rings on transverse section) or 'pseudokidney sign' (on longitudinal section). Once confirmed and if there are no signs of peritonitis or perforation, pneumatic (air) or hydrostatic (saline/water-soluble contrast) enema under fluoroscopic or sonographic guidance serves as both the diagnostic confirmation and initial therapeutic intervention, with reduction rates of 80-90%. Barium enema (option B) was the classic approach but has largely been replaced by pneumatic/saline enema. Surgery is reserved for failed radiological reduction or evidence of bowel ischemia/perforation.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.