A 9-month-old male infant is brought to the emergency department due to sudden episodes of severe, inconsolable crying during which he draws his legs up to his abdomen. Between episodes, he appears lethargic but calm. The parents report one episode of dark, bloody, mucus-like stool on the way to the hospital. He is tachycardic but normotensive, and the abdomen is soft with a palpable 'sausage-shaped' mass in the right upper quadrant. Arrange the following steps in the correct chronological sequence for the evaluation and management of this patient.
- 1Establish intravenous access and initiate fluid resuscitation
- 2Obtain an abdominal ultrasound
- 3Perform a pneumatic (air) or hydrostatic enema
- 4Proceed to surgical exploration
Answer
The correct sequence is: Establish intravenous access and initiate fluid resuscitation, followed by obtaining an abdominal ultrasound, then performing a pneumatic or hydrostatic enema, and finally proceeding to surgical exploration if necessary.
The standard of care for suspected intussusception strictly follows a sequential approach: stabilization (IV fluids) always comes first. Once the patient is hemodynamically stable, the diagnosis is confirmed via abdominal ultrasound. Following confirmation, therapeutic reduction is attempted non-operatively using a pneumatic or hydrostatic enema. Surgical exploration is the treatment of last resort, used only when enema reduction fails or is contraindicated.
Step-by-Step Solution
Key Concept
Algorithm for the acute management of pediatric intussusception