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Study for the USMLE Step 2, daily.
A 10-month-old boy presents to the emergency room with a 6-hour history of intermittent crying and refusing to feed. He had one episode of vomiting, which his parents report was green in color but free of blood. He passed loose, bloody stools on the way to the emergency room. Physical examination reveals an irritable infant with a temperature of 102.5°F and a palpable mass in the right upper quadrant. What is the most likely diagnosis?
Correct Answer:
Explanation:
Intussusception is the invagination of one portion of the bowel into itself, usually the proximal portion drawn into the distal portion by peristalsis. It has a peak incidence in infants ages 5 to 12 months with a male predominance. The classic triad of intussusception includes intermittent colicky abdominal pain, bilious vomiting, and “currant jelly” stool. Neurologic signs, such as lethargy, seizure, and apnea, may also be seen and can delay diagnosis. Physical examination frequently reveals a sausage-shaped mass in the right upper quadrant. Diagnosis is with ultrasound or contrast enema; contrast enema has therapeutic as well as diagnostic value. Intussusception most commonly occurs idiopathically but is also associated with viral infection or an anatomic lead point, such as a Meckel’s diverticulum, polyp, or lymphoma.
Quick Concepts:
Intussusception symptoms
– Intermittent colicky abdominal pain
– Bilious vomiting
– “Currant jelly” stool
Summary:
Suspect intussusception in infants with intermittent colicky abdominal pain, bilious vomiting, and “currant jelly” stool. Physical exam frequently reveals a sausage-shaped mass in the right upper quadrant. Diagnosis can be made with ultrasound or contrast enema.
Explanation:
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