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Intussusception

Discussion

A 9-month-old previously healthy boy is brought to the emergency department by his parents due to sudden onset of severe, intermittent abdominal pain. The parents report that the infant has been crying inconsolably, pulling his legs up towards his abdomen, and then appearing lethargic between episodes. They also noticed two episodes of vomiting, initially non-bilious, followed by a small amount of blood in his stool.

On physical examination, the infant appears uncomfortable and pale, with a tender abdomen. A sausage-shaped mass is palpated in the right lower quadrant. The infant’s stool is checked and found to have the characteristic “currant jelly” appearance, consisting of blood and mucus.

An urgent abdominal ultrasound confirms the diagnosis of intussusception, showing the classic "target sign." The infant is stabilized with intravenous fluids and taken for a therapeutic air enema reduction. The procedure is successful, and the infant recovers well without the need for surgery.

Questions
1. What is the most likely diagnosis for an infant presenting with severe intermittent abdominal pain, vomiting, and blood in the stool?

a). Pyloric stenosis

b). Intussusception

c). Appendicitis

d). Gastroenteritis

2. What is the characteristic finding on physical examination for intussusception?

a). Olive-shaped mass in the upper right quadrant

b). Diffuse abdominal tenderness without a palpable mass

c). Sausage-shaped mass in the abdomen

d). Tenderness over McBurney’s point

3. What type of stool is typically associated with intussusception?

a). Watery diarrhea

b). Currant jelly stool

c). Hard, pellet-like stool

d). Greasy, foul-smelling stool

4. What is the first-line treatment for intussusception in a stable patient?

a). Intravenous antibiotics

b). Immediate surgical intervention

c). Therapeutic air or barium enema reduction

d). Nasogastric tube decompression and observation

Reveal answers

Answers

  1. b). Intussusception
  2. c). Sausage-shaped mass in the abdomen
  3. b). Currant jelly stool
  4. c). Therapeutic air or barium enema reduction