9 month old white male T: 99.4 P 110 RR 30 BP: 90/60 presents with his Gen: normal appearing . NAD HEENT: PERRL, NCAT, mother. She states that oropharynx clear he was playing earlier CV: RRR, no m/r/g today when suddenly he Pulm: CTAB began screaming in Abdomen: sausage-shaped mass pain, followed by an in RUQ, NT, ND episode of calmness. Ext: 2+ pulses, No c/c/e This has recurred multiple times over the past few hours.
1- Crescent Sign: intussusception lead point into gas filled lumen2- Target Sign: Mass in RUQ forms shape of target, sometimes just appears as a mass.3- Absent RUQ bowel gas4- Signs of small bowel obstruction
IV & IV fluids If H&P convincing for Intussusception: Air Contrast Enema Notify Surgery prior to study due to risk of perforation This can be both diagnostic and curative If H&P is not convincing but still in differential Ultrasound 1st then Air contrast enema if indicated This is done as a less invasive method to look for intussusception and other causes of abdominal pain. Admit to hospital Recurrence rate of intussusception is 5-10%
Most common intestinal obstruction between 3 months and 6 years of age “Currant Jelly Stool” is a late manifestation that is only present in 50% of cases ; (75% have heme-positive stool) Should raise concern for intussusception if present but should have no bearing on decision if absent. Air contrast enema is both diagnostic and curative Air is preferred over contrast b/c if perforation occurs no barium introduced into peritoneum
In Left image, Note the outline of bowel telescoping proximally.
King, Lonnie. Pediatrics, Intussusception. http://emedicine.medscape.com/article/802424- overview Tintanelli’s Emergency Medicine: A Comprehensive Study Guide. Chapter Chapter 127 Pediatric Abdominal Emergencies Wahba, Mark. The Pediatric Abdomen: Intussusception. www.remergs.com. Oct 9, 2003 http://www.nlm.nih.gov/medlineplus/ency/imagepag es/1172.htm