Intussusception is the diagnosis that should be foremost in one's mind with a child aged between 3 months and 2 years presenting with sudden onset of severe colicky abdominal pain, coming at intervals of about 15 minutes and lasting 2-3 minutes. Early diagnosis, within 24 hours of the onset, is essential, for after this time there is a significant rise in morbidity and mortality. It is due to telescoping of the segment of bowel into the adjoining distal segment, e.g. ileocaecal segment, resulting in intestinal obstruction.
Typical clinical features
See Figure 30.6 .
• range: birth to school age, usually 5-24 months
• sudden onset acute pain with shrill cry
• pallor with attacks
• intestinal bleeding: redcurrant jelly (60%) 6
• pale, anxious and unwell
• sausage-shaped mass in RUQ, especially during attacks (difficult)
• signe de dance, i.e. emptiness in RIF to palpation
• alternating high-pitched active bowel sounds with absent sounds
• rectal examination: ± blood pale child severe 'colic' vomiting
• barium enema (avoid if dehydration, peritonitis or established bowel obstruction)
• hydrostatic reduction by barium enema under radiological control or hydrostatic reduction with oxygen
• surgical intervention may be necessary
• Acute gastroenteritis: can be difficult in those cases where there is some loose stool with intussusception and with blood and mucus without much watery stool in gastroenteritis. However, usually attacks of pain are of shorter duration, and there is loose watery stool, fever and no abdominal mass. If doubtful refer as possible intussusception.
• Impacted faeces can lead to spasms of colicky abdominal pain—usually an older child with a history of constipation.
• Other causes of intestinal obstruction, e.g. irreducible inguinal hernia, volvulus, intra-abdominal band.
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