A 4-month-old infant presents with intermittent paroxysmal abdominal pain, drawing up of knees, and a 'redcurrant jelly' stool. Abdominal ultrasound shows a 'target sign' in the right upper quadrant. Initial management is:
- A Pneumatic or hydrostatic (water/contrast) enema reduction under ultrasound or fluoroscopic guidance ✓
- B Immediate surgical laparotomy
- C IV antibiotics and nasogastric decompression only
- D Oral rehydration and observation for spontaneous resolution
Explanation
The 'target sign' on ultrasound is pathognomonic of intussusception, which is the most common cause of intestinal obstruction in children aged 3 months to 6 years. Provided there are no signs of perforation (peritonitis, pneumoperitoneum, haemodynamic instability), the first-line treatment is non-operative reduction by pneumatic (air) or hydrostatic (saline/contrast) enema under fluoroscopic or ultrasound guidance, with a success rate of 80–90%. Surgery is reserved for failed enema reduction or perforation. Antibiotics without reduction do not treat intussusception. Spontaneous resolution is unreliable.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.