A 10 months old boy, recently arrived from Guyana

Discussion in 'MRCS Forum' started by Lona., Nov 7, 2007.

  1. Lona.

    Lona. Guest

    A 10 months old boy, recently arrived from Guyana, has a 5 h history of crying with intermittent drawing up of his knees to his chest. On the way to the emergency room he passes a loose, bloody stool. He has had no vomiting and has refused his bottle since the crying began. Physical examination is noteworthy for an irritable infant whose abdomen is very difficult to examine because of constant crying. His temperature is 38.8c. (101.8 F). The Rectal ampulla is empty but there is some gross blood on the examining finger. The most helpful study in the immediate management of this patient would be -
    a- Stool culture
    b- Examination of the stool for ova and parasites
    c- An air contrast enema
    d- Examination of the blood smear
    e- Coagulation studies
  2. Lona.

    Lona. Guest

    Answer: - The answer is C. (Rudolph, 20/e, pp 1070-1072) The usual presentation of intussusception is that of an infant between 4 and 10 months of age who has a sudden onset of intermittent colicky abdominal pain. The child may appear normal when the pain abates, but as it recurs with increasing frequency, the child may begin to vomit and become progressively more obtunded. The passage of stool containing blood and mucus and resembling current jelly is often observed. Early examination of the abdomen may e unremarkable, but as the problem persists a sausage-shaped mass in the right upper quadrant is frequently palpated. A contrast enema examination under fluoroscopic control may be therapeutic as well as diagnostic when the hydrostatic effects of the column of air serve to reduce the intussusception. Early diagnosis prevents bowel ischemia. The cause of most intussusception is unknown, but a Meckel’s diverticulum or polyp may serve as a lead point.

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