A 6-month-old infant is brought to the emergency department with sudden paroxysms of severe colicky abdominal pain during which he draws his knees to his chest and screams inconsolably, alternating with periods of lethargy. Stool examination demonstrates blood and mucus resembling 'red currant jelly'. What is the definitive non-operative diagnostic and therapeutic procedure?

Answer and explanation

Correct answer: D. Ultrasound-guided pneumatic (air) or hydrostatic contrast enema reduction

  1. Step 1: Ileocolic intussusception is the most common cause of intestinal obstruction in infants aged 3 months to 3 years.
  2. Step 2: Pneumatic (air) or hydrostatic enema under fluoroscopic or ultrasound guidance achieves non-operative reduction in 80% to 90% of uncomplicated cases.
Answer
Ultrasound-guided pneumatic (air) or hydrostatic contrast enema reduction.
Why not the others: 'Urgent open exploratory laparotomy without imaging' is reserved for failed enema reduction, peritonitis, or shock; 'Upper gastrointestinal barium swallow series' evaluates upper GI pathology and is contraindicated in acute colonic obstruction; 'Flexible sigmoidoscopy with cold forceps mucosal biopsy' is ineffective and risks colonic perforation.

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