A 10-month-old girl is brought to the emergency department for evaluation of bright red stools. About an hour ago, the girl's mother found bright red-tinged formed stools mixed with mucus in the patient's diaper. The patient has had intermittent abdominal pain since yesterday. These episodes resolve after 10-15 minutes but have been occurring more frequently since this morning. The patient goes to day care, and several other children have had runny nose, vomiting, and diarrhea over the past week. She takes no medications, and her immunizations are up to date. Temperature is 37.3 C (99.1 F), blood pressure is 100/60 mm Hg, and pulse is 150/min. Examination reveals diffuse abdominal tenderness; the infant also appears tired. Fecal testing is positive for blood and negative for leukocytes. Which of the following is the most likely diagnosis in this patient?

Question

A 10-month-old girl is brought to the emergency department for evaluation of bright red stools.  About an hour ago, the girl's mother found bright red-tinged formed stools mixed with mucus in the patient's diaper.  The patient has had intermittent abdominal pain since yesterday.  These episodes resolve after 10-15 minutes but have been occurring more frequently since this morning.  The patient goes to day care, and several other children have had runny nose, vomiting, and diarrhea over the past week.  She takes no medications, and her immunizations are up to date.  Temperature is 37.3 C (99.1 F), blood pressure is 100/60 mm Hg, and pulse is 150/min.  Examination reveals diffuse abdominal tenderness; the infant also appears tired.  Fecal testing is positive for blood and negative for leukocytes.  Which of the following is the most likely diagnosis in this patient?

Quizplus · Accepted Answer

11ec25c8_d5e4_52b6_bc81_ad06807388bc_MD0003_00 This infant with bloody stools and intermittent abdominal pain most likely has intussusception, an intestinal disorder in which one segment of bowel telescopes into the lumen of another. bowel telescopes Typical presentation is sudden, episodic abdominal pain in a child age 6-36 months lasting about 15-20 minutes. Bouts of pain often increase in frequency and severity, and lethargy is common (particularly in infants) with progressive episodes. Emesis may accompany the abdominal pain; it is initially nonbilious but can become bilious due to bowel obstruction. In addition, stools may contain blood and mucus (ie, currant jelly appearance) from bowel wall ischemia. Some patients have abdominal tenderness or a sausage-shaped mass on the right side of the abdomen that may be palpated on examination. Recent viral illness or rotavirus vaccination are risk factors. currant jelly appearance Diagnosis can often be made by ultrasound, where the telescoped bowel appears as a target sign; air or saline enema is both diagnostic and therapeutic. Surgery is indicated if the enema does not reduce the intussusception or if imaging suggests a mass lesion. target sign (Choice A) Acute dysentery is characterized by infectious diarrhea that causes abdominal cramping and blood/mucus in the stool. This patient's formed stools, lack of fever, and absent fecal leukocytes make dysentery less likely. (Choice B) Appendicitis presents acutely with right lower quadrant abdominal pain, fever, and vomiting. Intermittent abdominal pain and bloody stools would not be classic. (Choice C) Crohn disease causes abdominal pain and bloody stools but rarely presents in infancy. In addition, fecal leukocytes would be expected due to intestinal inflammation. (Choice E) Juvenile polyps typically present in children age 2-10 with painless rectal bleeding. This patient's age and severe, episodic abdominal pain make this diagnosis unlikely. Educational objective: Intussusception (ie, telescoping bowel) is most common in children age 6-36 months and causes episodic abdominal pain, currant jelly stools, and lethargy. A palpable, sausage-shaped abdominal mass is not always present. References: Intussusception in children: a clinical review. (http://www.ncbi.nlm.nih.gov/pubmed/26559998)

A 10-Month-Old Girl Is Brought to the Emergency Department for Evaluation