Clinical Diagnosis: Acute Intussusception in an Infant
The clinical presentation strongly suggests acute intussusception based on the characteristic symptoms and examination findings in an infant.
Key Clinical Indicators
- Age and Symptoms: An eight-month-old male infant experiencing recurrent episodes of screaming and drawing up of legs indicates severe, intermittent abdominal pain, a hallmark of intussusception.
- Intermittent Distress: The observation that the child appears listless between attacks signifies the cyclical nature of the pain associated with intussusception.
- Abdominal Examination: The finding of an empty right iliac fossa is significant. It suggests that the intussuscepted bowel segment, typically starting at the ileocecal junction, has telescoped into the colon or moved proximally.
- Rectal Examination: The presence of blood-stained mucus on the examining finger, often termed "currant jelly stool," is a classic and highly specific sign of intussusception, caused by ischemia and sloughing of the engorged intestinal mucosa.
Differential Diagnosis Consideration
While other abdominal emergencies can occur in infants, they present differently:
- Volvulus (Caecal/Midgut): Often presents more acutely with persistent, severe pain, bilious vomiting, and signs of complete bowel obstruction. Bloody stools are typically a later sign, if present.
- Rectal Prolapse: This condition involves the protrusion of the rectal lining through the anus. It is usually visually apparent and does not typically present with the described colicky pain pattern or internal mass migration indicated by the empty RIF.
Conclusion
The combination of the infant's age, symptoms of severe intermittent colicky pain, characteristic "currant jelly" stools, and the specific abdominal finding (empty RIF) strongly points towards acute intussusception as the most probable diagnosis.
Important Questions from Intestines
- A 22-year female has presented with a history of malaise, cough, alternating constipation and diarrhoea with intermittent abdominal pain for last 6 months. She also complains of abdominal distension for last 2 days. On examination her abdomen has a doughy feel along with an ill defined mass over the right lower quadrant. She is most likely suffering from:
- Gentleman of 56 years underwent laparoscopic left hemicolectomy for diagnosed left colonic carcinoma. Histopathology revealed the tumour to be invading submucosa and muscularis propria. Among the 16 regional lymph nodes harvested, 2 were positive for malignant deposits.
His staging as per AJCC will be: - A 40 year old female patient presents with colicky abdominal pain associated with episodes of mild diarrhoea for last 6 months accompanied with intermittent fever and weight loss. There are multiple discharging sinuses on perineal examination. The most likely clinical diagnosis in this patient is:
- Which of the following statements regarding Ogilvie's syndrome are correct?
1. It presents as acute large bowel mechanical obstruction
2. Marked caecal dilatation is a common feature on X-ray abdo- men
3. Caecal perforation is a well recog- nized complication of this condi- tion
4. Intravenous Neostigmine is used for the treatment of this condition
Select the correct answer using the code given below : - Which of the following statements regarding Carcinoid tumour are correct?
1. Terminal ileum is the most common site for these tumours in the gastrointestinal tract
2. These tumors arise from Kulchitsky cells situated at the base of intestinal crypts
3. 5-Hydroxytryptamine is the most common vasoactive peptide produced by these tumors
4. Serum chromogranin A is a useful marker for disease recurrence
Select the correct answer using the code given below :
