Is it just colic?
A 7-month-old has bouts of inconsolable screaming every 15 to 20 minutes, drawing their knees up. Between bouts they are pale and unusually floppy. There is a sausage-shaped mass in the right upper abdomen.
What’s the most likely diagnosis?
Need a clue?
The pain comes in waves, and the baby is floppy in between. Where is the mass, and what shape is it?
Show the answer
- Diagnosis
- Intussusception
- Next step
- Resuscitate, then an air enema under imaging.
- What's going on
- One segment of bowel telescopes into the next, most often where the small bowel joins the large bowel (ileocolic). The trapped bowel swells and can lose its blood supply.
- Spot it
- Episodes of screaming with pallor and drawing up the legs, lethargy between bouts, and vomiting. Redcurrant jelly stool is a late sign, so don't wait for it.
- Test
- Ultrasound, which shows a target (doughnut) sign.
- Treatment
- Resuscitate first. An air enema under imaging reduces about 8 in 10 (a fluid enema, about 7 in 10). Surgery if the enema fails, or if there is peritonitis, perforation or shock.
- Why it matters
- Delay risks dead or perforated bowel. Peak age is 5 to 7 months, and about two thirds are under 1.
Go further
Tap a question to check your answer.
What's happening inside the bowel?
One segment telescopes into the next, usually where the small bowel meets the large bowel.
What stool sign might you see?
Redcurrant jelly stool, but it's a late sign, so don't wait for it.
What would the ultrasound show?
A target (doughnut) sign.
How can you fix it without an operation?
An air enema under imaging works in about 8 in 10 (a fluid enema, about 7 in 10).
Harder: when do you go straight to surgery?
Peritonitis, perforation or shock. Resuscitate first.
Source: Patient.info Professional
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