ROSH Gastrointestinal Practice Exam

What is the most appropriate definitive management for a 12-month-old boy with nonbilious vomiting and bloody stools?

1. Administration of broad spectrum antibiotics

2. Air-contrast enema

3. Nasogastric suction

4. Surgical reduction

The correct answer is: Surgical reduction

The most appropriate definitive management for a 12-month-old boy presenting with nonbilious vomiting and bloody stools is surgical reduction. This clinical presentation raises suspicion for intussusception, a condition where a part of the intestine telescopes into another section, leading to obstruction and potential ischemia. In intussusception, the classic symptoms often include intermittent abdominal pain, vomiting, and the passage of "currant jelly" stools, which can appear bloody due to mixed intestinal content. In young children, intussusception can result in significant morbidity if not addressed promptly. Surgical intervention is generally required for cases that do not respond to non-surgical treatments. Although other methods such as an air-contrast enema can sometimes be used to resolve intussusception non-operatively, definitive management is aimed at preventing complications like bowel necrosis, which can occur if the condition is left untreated. Therefore, surgical reduction is indicated in this situation, especially given the patient's age and the severity of the symptoms. In contrast, administering broad-spectrum antibiotics is not a definitive intervention for intussusception. While antibiotics may be utilized for associated infections, they do not resolve the underlying mechanical obstruction. Similarly, nasogastric suction is typically used