A 9-month-old infant suddenly develops paroxysmal episodes of drawing up both knees to the chest, crying inconsolably for 20 seconds, then appearing completely well. These occur every 15–20 minutes. A 'sausage-shaped' mass is palpated in the right hypochondrium. Ultrasound shows a 'target sign' in the right upper quadrant. What is the INITIAL management?
- A Emergency laparotomy with manual reduction
- B IV morphine for pain and observation for 24 hours
- C Pneumatic (air) enema under radiological guidance as both diagnostic and therapeutic ✓
- D Barium enema with concurrent surgery preparation
Explanation
Ileocolic intussusception is the most common cause of intestinal obstruction in infants aged 3 months to 3 years. Pneumatic air enema (or hydrostatic saline enema) under fluoroscopic or ultrasound guidance is both diagnostic (confirming intussusception) and therapeutic (non-operative reduction) and is successful in 75–85% of cases if there are no signs of peritonitis or perforation. Contraindications to non-operative reduction include signs of peritoneal irritation, hemodynamic instability, perforation, or failed first attempt. Surgery is reserved for failed enema reduction, perforation, or prolonged obstruction >24–48 hours.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.