A 9-month-old infant presents with sudden onset inconsolable crying, drawing up of knees to the chest, and passage of a 'redcurrant jelly' stool. An abdominal mass is palpable in the right upper quadrant. Ultrasound shows a 'target sign' (pseudo-kidney sign) in the right upper quadrant. What is the INITIAL treatment of choice if the infant is hemodynamically stable with no perforation or peritonitis?

• A Emergency laparotomy and manual reduction of the intussusception
• B IV antibiotics and expectant management, as ileocolic intussusception commonly resolves spontaneously
• C Air or hydrostatic (contrast/saline) enema reduction under fluoroscopic or ultrasound guidance ✓
• D Nasogastric suction and IV fluid resuscitation as definitive treatment for early intussusception

Explanation

In ileocolic intussusception without signs of perforation, peritonitis, or hemodynamic instability, pneumatic (air) or hydrostatic (barium/saline) enema reduction under fluoroscopic or ultrasound guidance is the initial treatment of choice, with success rates of 75–90%. It avoids surgery in the majority of cases. Laparotomy is reserved for failed enema reduction, peritonitis, perforation, or clinical instability. Intussusception does NOT resolve spontaneously in infants—delay risks bowel ischemia and perforation. NGT suction and fluids are adjunctive supportive measures but not definitive.

Reference: Ghai Essential Pediatrics, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.