Case: A 2 year-old male with no significant PMH is brought to the Emergency Department by his mother for intermittent abdominal pain for the past two days. Mom notes that the child will crouch down into a ball when he has pain, which lasts only a few minutes at a time. He has decreased solid food intake but no vomiting or diarrhea and is otherwise well.

Vital Signs:
Temp: 98.7 F
HR:138
RR: 30
SpO2% 98% RA

Physical Exam:  Well-appearing boy playing in room, active, alert, and interactive with examiner.  No tenderness or discomfort with abdominal exam.

An abdominal plain film is ordered which is significant for a paucity of bowel gas in the distal half of the intestines. 

An abdominal ultrasound is then ordered, which is significant for the following images: 

Question: Treatment would consist of which of the following?
A) Surgical De-torsion of volvulus
B) Air or water-soluble contrast enema
C) Removal of appendix
D) Pyloromyotomy
E) Bowel Resection

ANSWER