An 11-month-old girl presents with fever and purple current jelly stools; a palpable RUQ mass is noted. What is the next step in management?

• A. Observation
• B. Contrast enema
• C. Immediate surgery
• D. Ultrasound

Answer: (B)

Intussusception in an infant presents with intermittent abdominal pain, vomiting, and the classic currant jelly stools plus a sausage-shaped RUQ mass. The priority is to promptly reduce the telescoped segment to relieve obstruction and restore blood flow. A contrast enema (hydrostatic or air) under fluoroscopy is the best next step because it can both diagnose and nonoperatively reduce the intussusception. If reduction succeeds, the child can be observed and discharged; if it fails, or if there are signs of perforation or peritonitis, surgical management is needed. Observation alone is inappropriate due to ongoing risk of bowel ischemia. Ultrasound helps with diagnosis, but in this classic presentation the reduction by enema is preferred over delaying for imaging. Immediate surgery is reserved for peritonitis, perforation, shock, or failed nonoperative reduction.