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Ileocolic Intussusception, Suspected — History and Physical Exam — Clinical Pathway: Emergency Department

Suspected Ileocolic Intussusception Clinical Pathway — Emergency Department

History and Physical Exam

  • Consider the differential diagnosis:
    • Gastroenteritis/colitis, appendicitis, ovarian torsion, incarcerated hernia
    • Acute head trauma, intoxication, metabolic abnormality, infection

Ileocolic intussusception without pathologic lead point is commonly seen in healthy children within the age range of 6 months to 3 years old. For children outside of this age range, review need for further evaluation to identify a pathologic lead point.

History

Pain
  • Severe intermittent colicky abdominal pain
  • Knee to chest during episodes of pain
  • Tired once pain resolves
GI
  • Assess oral intake, urine output
  • Anorexia, vomiting
  • Small or normal bowel movement
  • Currant jelly stool is a late finding
Altered Mental Status
  • Listless
  • Lethargic
  • Unresponsiveness is a late sign
Recent Medical History
  • Viral illness, fever
  • Immunizations

Physical Exam

Physical Exam
  • Mental status, vital signs
  • Tenderness, signs of peritonitis
  • Audible peristaltic rushes
  • Palpable mass in right mid, upper quadrant
  • Right lower abdomen flat or empty
  • Rectal examination with:
    • Blood, bloody mucus, intussusceptum prolapse

 

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