Physical findings common for intussusception.
This may be difficult to differentiate
from other signs of abdominal pain.
Patients may vomit.
Initially, the vomiting is non-bilious.
This is reflexive.
Don't be confused.
This is not a diagnosis of
hypertrophic pyloric stenosis,
which, as you know,
results, in non-bilious emesis
and projectile vomiting.
the emesis is usually bilious.
Now, the emesis is due to
a small bowel obstruction.
The patient may have abdominal pain.
Particularly with worsening abdominal pain,
you should be concerned about ischemia
or impending ischemia.
And sometimes, passage
of bloody stools.
I hope you don't like
currant jelly stool
because this is what is
classically described as bloody stools
What laboratory findings might you find?
due to the vomiting,
you may classically find low sodium,
and low bicarb.
particularly with signs of ischemia,
you may find a child with an
elevated white blood cell count
Let's move on to imaging to help diagnose.
Ultrasound, remember, is
incredibly helpful in the young.
We try not to expose our babies and infants
to radiation as much as possible.
Again, to remind you,
the abdominal wall of
a child is usually thin
and quite amenable to ultrasound techniques.
As you can see
on this ultrasound image,
this is a classic target sign.
Notice the white circle in
the middle of the screen,
that's the portion of the intestines
or telescoped into
the proximal bowel.
Also important to notice,
the thick black band
around the inside circle
is edematous proximal bowel.
Remember our discussion about
venous and lymphatic congestion.
This finding is consistent with
potentially ischemic bowel
and this patient may need surgery.
Abdominal x-rays unfortunately
are much less reliable.
we’ll shortly discuss
why contrast studies
may actually be both
diagnostic and therapeutic.
This is a cross-sectional CAT scan
of the abdomen and pelvis
clearly in an adult.
I want to point out to you that
intussusception can happen in adults as well.
And it's rare for us to
get a CAT scan in children.
Do you notice the target sign here
shown by the white arrow?
It looks remarkably similar
to the ultrasound, doesn't it?