Chapter 51

Question 1

How does a patient present with intussusception?

Answer 1

Sudden inset of intermittent crying spells, draws legs towards abdomen between attacks child is relatively comfortable and lethargic, experiences episodic emesis. Symptoms preceded by URI

Question 2

What are the ultimate differentials for this patient?

Answer 2

Intussception, small bowel obstruction, Meckel’s diverticulum, testicular torsion, vulvulus, Henoch-Schonlein purpura, Gastroenteritis, and appendicitis

Question 3

How does this patient present during physical examination?

Answer 3

Tender sausage shaped right abdominal mass, Guaiac positive stool mixed with mucus, distended abdomen

Question 4

What makes this patient not likely to have meckel’s diverticulum?

Answer 4

Meckel’s diverticulum usually presents with painless rectal bleeding especially if not associated with volvulus or intusssusception

Question 5

What is the most common location and age group for intussusception?

Answer 5

six months to three years; ileocolic lesion

Question 6

What are examples of pathological lead points?

Answer 6

Parasites, Meckel’s diverticulum, polyps

Question 7

What is the preferred imaging diagnosis to confirm?

Answer 7

Abdominal ultrasound

Question 8

What is the diagnostic procedure that can be done obviating the need for surgery?

Answer 8

Contrast enema is diagnostic and therapeutic

Question 9

After confirmed that diagnosis with an abdominal ultrasound, what should be done?

Answer 9

Plain abdominal radiograph to exclude perforation and surgical consultation

Question 10

What lab test should be ran in order to evaluate bile necrosis, acidosis, electrolyte abnormalities, and degree of dehydration?

Answer 10

CBC and BMP

Question 11

What are the initial diagnosis that should be given to this patient?

Answer 11

CBC BMP Plane abdominal radiograph and abdominal ultrasound

Question 12

After confirmation we should be given for supportive therapy?

Answer 12

NPO, IV hydration, insertion of NG tube for decompression and surgical consultation Contrast enema

Question 13

When should nonoperative reduction under flouroscopic or sonographic guidance using hydrostatic or pneumatic pressure be appropriate?

Answer 13

If intussusception is without perforation or ischemia

Question 14

In the case of a successful reduction what should be done?

Answer 14

Patient should be admitted to the hospital and observed for at least 12 to 24 hours possible complications

Question 15

How common are complications of reductions?

Answer 15

10% and are more common in lead points

Question 16

When are multiple non-surgical reduction indicated?

Answer 16

In reoccurrence of intussusception

Question 17

When is surgery indicated for these patients?

Answer 17

If complicated intussusception Or in multiple unsuccessful non-operative reductions

Question 18

What are examples of complicated intussusception?

Answer 18

Hemodynamically unstable, perforation, bowel necrosis, presence of pathological lead point