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You are seeing a 13-month old toddler who presents with 1 day of lethargy and 2 episodes of vomiting. There is no fever or diarrhea. The child has not complained of or seemed to have abdominal pain. The child has been sleeping all day and has not taken any oral intake. On exam, temperature is 37.6C, HR 110, RR 30, BP 76/32, pulse oximetry 100% on room air. The abdominal exam is nondistended, nontender, and no mass is palpable. The rest of the exam is normal.
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May 7, 2024 at 5:43 pm
D) Intussusception
The classic presentation of intussusception includes colicky abdominal pain episodes and vomiting, progressing to currant-jelly stool. Sometimes a sausage-shaped mass is palpable in the right side of the abdomen. However, an atypical presentation is lethargy, with no obvious abdominal pain. This presentation if more common in infants. Pyloric stenosis presents at a younger age (rare after age 3 months) with projectile vomiting. Annular pancreas can mimic pyloric stenosis, or may be asymptomatic. Appendicitis would result in abdominal tenderness on exam. Partial Hirschsprung’s presents with chronic constipation.