A 2-year-old child presents with colicky abdominal pain and red-currant jelly stools. Ultrasound shows a 'target sign' (concentric rings) in the right iliac fossa. What is the most appropriate initial treatment?
- A Surgical reduction via laparotomy
- B IV antibiotics and watchful waiting
- C Air or hydrostatic (saline/contrast) enema reduction under fluoroscopic guidance ✓
- D Barium enema only for diagnosis, not treatment
Correct answer: C. Air or hydrostatic (saline/contrast) enema reduction under fluoroscopic guidance
Explanation
Intussusception in a hemodynamically stable child without peritonitis is treated by pneumatic (air) or hydrostatic enema reduction under fluoroscopy or ultrasound guidance, which has a success rate of 80–90%. The 'target sign' (also called 'pseudokidney sign' in longitudinal view) on ultrasound is the diagnostic finding. Contraindications to non-surgical reduction include free perforation, peritonitis, or hemodynamic instability — only then is surgery performed. Barium enema is now rarely used and air enema is preferred.
Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.
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