A 4-month-old infant is brought with intermittent episodes of drawing up knees to the chest, inconsolable crying lasting 15–20 minutes, and passage of 'redcurrant jelly' stool. Abdominal ultrasound shows a target sign in the right upper abdomen. After initial stabilisation, the first-line treatment is:

• A Emergency laparotomy and manual reduction
• B Pneumatic (air) enema reduction under fluoroscopic guidance ✓
• C IV antibiotics and observation for 24 hours
• D Barium enema reduction

Explanation

Intussusception in a haemodynamically stable infant without peritoneal signs is best treated with non-operative pneumatic (air) enema reduction under fluoroscopic or ultrasound guidance, which is successful in 70–90% of cases and avoids surgical risks. Barium enema has been superseded by air enema (lower perforation risk, less radiation). Laparotomy is reserved for failed enema or peritonitis.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.