Images in Emergency Medicine

Article Outline

• Diagnosis
  • Intussusception
• References
• Copyright

[Ann Emerg Med. 2008;52:307.]

A previously healthy 11-month-old girl presented to the emergency department with repeated episodes of bilious emesis during the previous day. Just before arrival, the mother observed a bloody bowel movement, which she saved in the child's diaper (Figure 1).

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• Figure 1. 

  “Currant jelly” stool.

Vital signs included a temperature of 38.6°C (101.5°F) and a pulse of 168 beats/min. The child appeared listless, with dry mucous membranes and a protuberant, tympanitic abdomen. An abdominal radiograph was obtained (Figure 2).

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• Figure 2. 

  Abdominal obstructive series, including posteroanterior chest radiograph. Used with permission of the Department of Radiology, Mercy Hospital, as associated with the University of Illinois at Chicago Radiology and Emergency Medicine Residency Programs, University of Illinois College of Medicine, Chicago, IL.

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Diagnosis 

Intussusception 

Guaiac testing of the “currant jelly” stool was markedly heme positive. The patient was resuscitated with intravenous fluids and broad-spectrum antibiotics. Reduction was attempted unsuccessfully with a barium enema. Ultimately, the child underwent successful open reduction in the operating room.

Intussusception is the most common cause of intestinal obstruction in children between 3 months and 6 years of age, with a peak incidence at 6 to 11 months of age.¹ It is caused by a prolapse or “telescoping” of one part of the intestine into the lumen of an adjacent segment, most commonly at the ileocecal valve. The exact cause is often unclear but may involve a pathologic “lead point” in the intestine cause by a polyp, lymphoma, or enlarged lymph nodes.² The classic triad of symptoms is abdominal pain, vomiting, and bloody stool.³ The criterion standard for diagnosis remains barium or air enema because it is often both diagnostic and therapeutic.³ Surgical reduction is necessary in cases of failed reduction by enema and in those cases with clinical signs of perforation or peritonitis.⁴

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References 

1. McCollough M, Sharieff GQ. Abdominal pain in children. Pediatr Clin North Am. 2006;53:107–137
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2. Wyllie R. Ileus, adhesion, intussusception, and closed-loop obstructions. In:  Behrman RE,  Kliegman RM,  Jenson HB, et al. editor. Nelson Textbook of Pediatrics. 17th ed.. Philadelphia, PA: Saunders; 2004;p. 1242–1243
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3. Hostetler MA. Gastrointestinal disorders. In:  Marx JA,  Hockberger RS,  Walls RM, et al. editor. Rosen's Emergency Medicine: Concepts and Clinical Practice. 6th ed.. Philadelphia, PA: Mosby; 2006;p. 2610–2612
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4. Mallory B, Popowich Y. Intussusception. Operat Tech Gen Surg. 2004;6:330–334
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