MEDizzy - A 3-year-old girl presents with the abrupt onset of colicky

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Gastrointestinal System

A 3-year-old girl presents with the abrupt onset of colicky abdominal pain, abdominal distention, and stool with blood and mucus (“currant jelly” stools). Physical examination finds a slightly tender, sausage-shaped mass in the right upper quadrant of her abdomen. Which of the following is the most likely diagnosis?

ExplanationIntussusception refers to a condition in which one portion of the GI tract is pulled into the lumen of an adjoining portion of the GI tract. The most common location for this is the terminal ileum, and there are two types of patients who are most at risk, namely weaning infants and adults with a polypoid mass. It is thought that in weaning infants, exposure to new antigens causes hypertrophy of the lymphoid follicles in the terminal ileum and this may result in intussusception. Intussusception produces a classic triad of signs that includes sudden colicky abdominal pain, abdominal distention, and a “currant jelly” stool due to the vascular compromise produced by pulling of the mesentery. In contrast, the combination of fever, leukocytosis, and right lower quadrant abdominal pain is suggestive of acute appendicitis, while fever, leukocytosis, and left lower quadrant abdominal pain is suggestive of acute diverticulitis. Finally, a volvulus, which is a “twisting” of the intestines, also produces acute abdominal pain, inability to pass flatus, and a markedly distended abdomen, but it usually occurs in the sigmoid colon of the elderly due to redundant mesentery. A barium study may show a “bird beak” sign.