Case history
Case history
A 9-month-old boy presents to the emergency department with a 24-hour history of colicky abdominal pain, anorexia, fever, and progressive lethargy. Episodes of pain last 1 to 2 minutes marked by crying and drawing his knees to his chest, alternating with 20-minute pain-free periods where he behaves normally. The infant has vomited yellow material several times, which became green just prior to coming to hospital. Just prior to presentation, he had a bowel movement that appeared red, similar to redcurrant jelly. An abdominal examination reveals a distended, tender abdomen with pain out of proportion to examination, and a palpable right-sided abdominal mass. This could only be felt when he was settled between waves of pain, and was easiest to feel when he was lying on his side on his mother’s lap.
Other presentations
The classic triad of intussusception includes colicky abdominal pain, red currant jelly stool, and a palpable abdominal mass. This complete triad is present in 20% to 40% of patients. In 60% of patients, at least 2 of these features are present at the time of presentation.[2] Lethargy has also been identified as a common presenting symptom of intussusception.[3] Symptoms that have been identified as independently predictive of intussusception include rectal bleeding, history of vomiting, and male sex.[4]
Ileo-ileal intussusception can occur as a postoperative event, typically following abdominal surgery, especially resection of a Wilm’s tumour or neuroblastoma, pull-through for Hirschsprung’s disease, and correction of malrotation.[5]
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