2 weeks after a viral respiratory illness, an 18-mo child

Discussion in 'MRCS Forum' started by Abbas., May 28, 2008.

  1. Abbas.

    Abbas. Guest

    Approximately 2 weeks after a viral respiratory illness, an 18-month-old child complains of abdominal pain and passes some bloody mucous per rectum. A long thin mass is palpable in the right upper quadrant of the abdomen. Intussusception is suspected. Correct statements concerning intussusception in infants include which of the following?

    a- Recurrence rates following treatment are high
    b- It is frequently preceded by a gastrointestinal viral illness
    c- A 1- to 2-week period of parenteral alimentation should precede surgical reduction when surgery is required
    d- Hydrostatic reduction without surgery rarely provides successful treatment
    e- The most common type occurs at the junction of the descending colon and sigmoid colon
  2. Abbas.

    Abbas. Guest

    Answer: b. (Schwartz, 7/e, pp 1132-1734) Intussusception is the result of invagination of a segment of bowel into distal bowel lumen. The most common type is ileocolic, which typically appears as a coiled spring on barium enema. Ileoileal and colocolic intussusceptions occur less commonly and are not easily diagnosed on barium enema. If bloody mucus, peritonitis, or systemic toxicity have not developed, hydrostatic reduction by barium enema is the appropriate initial treatment. Most patients are successfully managed this way and do not require surgical intervention. Immediate treatment should be instituted to avert the danger of bowel infarction. Recurrence is surprisingly uncommon after either surgical or non-surgical treatment.

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