Question of the week # 299

299) A 10 month old male infant  is brought by his concerned mother to the Emergency room with complaints of vomiting and bloody diarrhea. Mother reports that he suffered from “stomach flu” symptoms about 1 week ago which resolved spontaneously.  He had 4 episodes of vomiting since yesterday and has been crying intermittently every 15 minutes. There is no blood or bile in the vomitus. He had four loose stools with blood in it. There is no history of fever or cough or cold. His past medical history is unremarkable. On examination, temperature is 98.4F,  pulse 112, respiratory rate 30/min and blood pressure at 80/50 mm hg. Oral mucosa appear moist and skin turgor is adequate. Abdomen is soft with no palpable masses. Bowel sounds are present. Stool guaiac is strongly positive. Stool is sent for cultures and abdominal x-rays are obtained. An x-ray image is shown below:

Which of the following is the most appropriate next step in managing this condition?

A) Abdominal ultrasound

B) Gastrograffin enema

C) Surgery

D) Rectal tube placement

E) Flexible sigmoidoscopy

22 Responses

  1. C….

  2. E

  3. I think gastrograffin enema is required

  4. c

  5. Intussusception first do ultrasound to confirm.

  6. Abd us

  7. D

  8. its intussusception do barium enema…..it will be t/t plus diagnosis….
    .

  9. b

  10. C……..For any kind of small bowel obstruction, we have to do the same.

    General principles in the medical treatment of small-bowel obstruction include the following:

    Stabilize the patient and monitor ABCs


    Replace fluids with diligent intravenous (IV) resuscitation, using isotonic sodium chloride solution or lactated Ringer solution


    Early bowel decompression with an NG tube decreases the chance of bowel necrosis and perforation


    Administer broad-spectrum antibiotics when necrosis or perforation is suspected

    Children whose symptoms persist longer than 24 hours, or have signs of peritonitis, should not be considered candidates for enema reduction. Stabilize these children and immediately transport them to the operating room because untreated intussusception is almost always fatal. The recurrence rate is higher after radiographic than after surgical reduction. Surgery is also indicated for patients whose intussusception cannot be reduced after 2 enema attempts.

  11. bbb

  12. Dx and tx at the same time w/ gastrografin

  13. A) Abdominal ultrasound
    In Intussusception,
    start with Abdominal X-ray—>Abdominal perforation present—>laparotomy
    —->No perforation but intestinal obstruction
    present—->Abd Ultrasound
    Abdominal ultrasound—>Positive—>Air enema

  14. ans : D

    Gastrograffin enema is both diagnostic and therapeutic .

    • I think you mean option B. 🙂

  15. C-surgery because patient has free intraperitoneal gas indicating perforation.

  16. There is frequent problem with this if us or enema, you never know and and went u select one is the other, I think is enema

  17. The child has likely intussusception. There is no fever, no abdominal tenderness and bowel sound is present – it shows the intestine is not impending gangrene and he does not need emergency surgery right now. Ba enema is both diagnostic and therapeutic for intussuception.
    Answer B.

  18. this is nt gas under diaphragm

  19. answer a
    x ray showing s/o obstrctn

  20. B. Less than 1 yr old with bowel obstruction, first try enema

  21. (B)the clinical picture is typical for intussception(intermttent colics). Gastrografin ia diagnostic and may reduce the intussception.

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