Suspected intussusception — MRCEM SBA MCQ

Instant feedback + full explanation. One question, done properly.

EasyPaediatric emergenciesSuspected intussusceptionMRCEM SBA

A 9-month-old boy is brought to the emergency department after six hours of episodes of sudden, inconsolable crying during which he draws up his legs and becomes pale. He has vomited twice; the vomit is not green. Between episodes he settles and his abdomen is soft. He is currently alert and well perfused. His stools contain no visible blood. An abdominal radiograph shows no definite obstruction or free gas. What is the most appropriate management plan now?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Arrange urgent ultrasound with paediatric surgical review.

The combination of episodic severe distress, leg-drawing, pallor and vomiting in an infant raises strong suspicion of intussusception, even though he appears well between episodes and has no visible rectal bleeding. A normal or inconclusive abdominal radiograph cannot exclude it. Urgent abdominal ultrasound and early paediatric surgical assessment are therefore the appropriate next steps. Keep him under observation, withhold feeds, establish intravenous access and provide analgesia while assessment proceeds. ([clinicalguidelines.scot.nhs.uk](https://www.clinicalguidelines.scot.nhs.uk/ggc-paediatric-guidelines/ggc-paediatric-guidelines/emergency-medicine/surgical-and-urological-advice-for-rhcg-ed/?utm_source=openai)) A is inappropriate because the history warrants investigation rather than discharge. B recognises a need for ultrasound but incorrectly makes it contingent on another observed episode; the episodes already reported are sufficient. C is attractive because an air enema can reduce intussusception, but in this stable child it should follow diagnostic assessment and surgical discussion. E bypasses the usual diagnostic and non-operative pathway: urgent surgery would become appropriate if perforation were suspected, the child were too unwell for an enema, or enema reduction failed. None of those conditions is present here. ([cuh.nhs.uk](https://www.cuh.nhs.uk/patient-information/intussusception-in-children/))

Reference: Surgical and Urological Advice for RHCG ED — Suspected / possible Intussusception (Last reviewed 2 August 2022) — https://www.clinicalguidelines.scot.nhs.uk/ggc-paediatric-guidelines/ggc-paediatric-guidelines/emergency-medicine/surgical-and-urological-advice-for-rhcg-ed/ Intussusception – in children (Approved 29 July 2025) — https://www.cuh.nhs.uk/patient-information/intussusception-in-children/ Intussusception and its treatment (Publication date not stated on document) — https://www.ouh.nhs.uk/media/sdncnqxu/65485intussusception.pdf