Master the board step 3

Master the Boards: USMLE Step 3
Intussusception
A 16-month-old child is seen for cramping and colicky abdominal pain for the past
12 hours. He has a 1-week history of diarrhea but developed episodes of vomiting
and passed black-bloody stool today. Physical examination is remarkable for
a lethargic child; abdomen is tender to palpation. Temperature is 101.3°F. White
blood count is 18,000. Which of the following is the most important next step in
management?
a. Antibiotic prophylaxis
b. Bowel resection
c. Electrolyte replacement
d. Embolectomy
e. Reduction of bowel
Answer: E. Reduction of telescoped bowel is the priority of management in patients
presenting intussusception.
Intussusception is the telescoping of bowel that classically occurs in children
< 2 years, often following gastrointestinal or upper respiratory infection, or it
may occur spontaneously in patients with a “lead point” (Meckel diverticulum,
polyp, neurofibroma, hemangioma) or with a history of Henoch-Schönlein
purpura.
The case will describe sudden paroxysms of colicky abdominal pain in a
lethargic child along with shock and fever. The classic “black currant jelly”
stool results from mucosal necrosis due to venous obstruction.
Proximal
part
Retention of intestinal content
in distended bowel above
intussusception
Intussuscepted
part of bowel
Distal
part
Intussusception
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