A 3-year-old child presents with sudden severe colicky abdominal pain during which he pulls his knees to his chest and screams. In between episodes, he is lethargic. Stool examination demonstrates blood mixed with mucus ('red currant jelly stool'). Abdominal ultrasound reveals a 'target sign' in the right upper quadrant. What is the definitive initial diagnostic and therapeutic intervention?

Answer and explanation

Correct answer: A. Air or hydrostatic contrast enema reduction

  1. Step 1: Classic presentation of ileocolic intussusception: Episodic paroxysmal colic, lethargy, 'currant jelly' stools, and concentric bowel rings ('target' or 'doughnut' sign) on ultrasound.
  2. Step 2: In the absence of peritonitis or bowel perforation, pneumatic (air) or hydrostatic contrast enema under fluoroscopic/ultrasound guidance is the first-line procedure, successfully reducing > 80% of cases non-operatively.
Answer
Air or hydrostatic contrast enema reduction.
Why not the others: 'Immediate laparotomy' is reserved for failed enema reductions, bowel necrosis, or perforation; 'Upper GI series' evaluates malrotation, not intussusception; 'Antibiotics' alone do not resolve mechanical intussusception.

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