A 2-year-old Caucasian boy is hospitalized with abdominal pain and vomiting. After initial evaluation laparotomy is performed, and a portion of the intestine is resected (see the slide below). This patient most likely suffers from:

Question

A 2-year-old Caucasian boy is hospitalized with abdominal pain and vomiting.  After initial evaluation laparotomy is performed, and a portion of the intestine is resected (see the slide below).  This patient most likely suffers from:

Quizplus · Accepted Answer

This is a surgical specimen that has a portion of the intestine open with a necrotic segment found in the lumen. This is a typical picture of intussusception, an invagination of a portion of the intestine into the lumen of the adjacent intestinal segment (imagine a collapsed telescope). Intussusception leads to impaired venous return from the invaginated segment of the bowel, which can cause ischemia and subsequent necrosis of the intestinal wall. The most typical location for intussusception is at the ileocolic junction. The size differences in the adjacent segments of the intestine allow the small bowel to invaginate into the cecum. Intussusception is most common in children younger than 2 years old. In this age group, it often occurs without any structural cause (sometimes associated with viral infection). In patients older than 2 years of age, a lead point, such as Meckel diverticulum, foreign body, or intestinal tumor, should be sought. Clinical presentation is colicky, intermittent abdominal pain, nausea, vomiting, and "currant jelly" stools (that contain blood and mucus). A tubular mass may be palpable in the lower right abdominal quadrant. Barium enema is diagnostic and may be therapeutic. If the intussusception does not resolve with barium enema, surgical intervention is mandated. Educational Objective: Intussusception most often occurs in children younger than 2 years of age and in the region of the ileocecal valve. It manifests with intermittent, severe, colicky abdominal pain, "currant jelly" stools, and sometimes a palpable mass in the right lower abdominal quadrant.

A 2-Year-Old Caucasian Boy Is Hospitalized with Abdominal Pain and Vomiting