An 18-month-old girl has had several episodes of nonbilious vomiting that started an hour before her ED visit. The patient's mother denies any rhinorrhea, fever, cough, or a history of a fall, although she notes that the girl has been crying more than usual. The girl is noted to be lethargic, pale, and weak on arrival. After intravenous fluids, she continued to vomit. An abdominal radiograph is suggestive of intussusception. You know that:
Intussusception is the most common cause of intestinal obstruction in infants between 6 and 36 months of age.
+A normal abdominal radiograph rules out intussusception.
+The classic triad of colicky abdominal pain, palpable abdominal mass, and currant jelly stools is seen more than 90% of the time.
+Contrast enema is the preferred method of diagnosis and treatment in patients with intussusception without signs of perforation or peritonitis.
+The lack of stools mixed with blood and mucous (“currant jelly” stools) virtually rules out this condition.
Intussusception is the most common cause of intestinal obstruction in infants between 6 and 36 months of age. It results from the invagination or telescoping of a portion of the proximal intestines into an area just distal to it. The classic triad of colicky abdominal pain, palpable abdominal mass, and currant jelly stools is seen in only 15% of the time. Some patients present with lethargy or an encephalopathic picture due to the release of endorphins from the ischemic bowels into the bloodstream. Several radiographic findings, such as the crescent sign and the target sign, if present, make the diagnosis more likely. Up to 25% of cases have normal abdominal radiographs. Ultrasound is used most often to make the diagnosis. Air enema, rather than contrast enema, is the preferred method of diagnosis and treatment in patients with intussusception without signs of perforation or peritonitis. Approximately 10% will have recurrence of the intussusception within 24–48 hours after reduction.