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You are seeing a 2yo patient with 6 hours of intermittent episodes of apparent abdominal pain happening every 15-20 minutes, and non-bloody non-bilious vomiting. In between episodes, the child appears well and is playful. There is no fever, diarrhea, or concern for toxic ingestion. The child has a history of constipation with hard stools and occasional skipped days with no stooling. There is no other significant past medical history.
Kelly May 26, 2020 - 12:57 pm
D) Once successfully treated, the child must be admitted for observation
The child is presenting with a classic presentation for intussusception. Palpable abdominal sausage-like mass in the right mid to upper abdomen and bloody currant-jelly stool are also associated with intussusception, but often are not present at ED presentation / early in the process. Diagnosis is made by ultrasound. Although constipation sometimes causes colicky abdominal pain, vomiting is uncommon, and intussusception should be ruled out before constipation is considered as a diagnosis of exclusion. Intussusception can be due to a pathologic lead point such as a polyp or Meckel’s diverticulum, and is also associated with viral gastroenteritis, particularly with adenovirus, which may be a result of intestinal lymphoid hyperplasia as a reaction to the viral disease. Treatment is by hydrostatic reduction in most uncomplicated cases, and if the patient’s pain is relieved, is tolerating oral intake, and the family can return expeditiously as needed, admission is not necessary.