An 18-month-old child has a 1-day history of intermittent, cramping abdominal pain with non-bilious vomiting. The child is observed to scream and draw up his legs during pain episodes and becomes lethargic in between. The primary care pediatric nurse practitioner notes a small amount of bloody, mucous stool in the diaper. What is the most likely diagnosis?

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Quizplus · Accepted Answer

The intermittent, cramping abdominal pain with vomiting, along with lethargy and drawing up of legs suggest abdominal pain. The presence of bloody, mucous stool suggests lower gastrointestinal bleeding. These symptoms, along with the age of the child, are highly suggestive of intussusception, which is a condition where a portion of the intestine telescopes or invaginates into another part, causing blockage and eventually decreasing blood flow, leading to ischemia and necrosis. Appendicitis typically presents with continuous abdominal pain, fever, and with a focus on the right lower quadrant of the abdomen. Gastroenteritis usually causes diarrhea, vomiting, and abdominal pain, but typically does not have bloody stool. Testicular torsion is a condition affecting the male genitalia and is not relevant for this child's symptoms.

An 18-Month-Old Child Has a 1-Day History of Intermittent, Cramping