Diagnosing Pediatric Intussusception Through Bedside Ultrasound by Novice Emergency Department Sonographers: A Case Report

Abstract

ABSTRAK Intususepsi merupakan satu kejadian kecemasan gastrousus yang terjadi dalam ABSTRACTIntussusception is a common cause of gastrointestinal emergency in the paediatric population and it is usually diagnosed through Barium enema radiography or 322 Med & Health Dec 2017;12(2): 321-328 Farah N.A. & Ismail M.S. ultrasound. The skill of using an ultrasound by a minimally trained medical officer in diagnosing this cases in the Emergency Department are very helpful and expedite the management. We present the case of a 7-month-old girl who presented to Emergency Department (ED) with the chief complaint of passing blood in stool. Clinically she was dehydrated, irritable and in compensated shock. There was generalised tenderness per abdomen but it was soft and not distended. There was no palpable mass and bowel sound normal. Immmediate fluid resuscitated commenced. Bedside abdominal ultrasound performed by ED medical officer showed a 1.8 cm x 2.5 cm mass of alternating hypo-echoic and hyper-echoic rings at the right lower quadrant, consistent with the 'target' sign of intussusception. Supine plain abdominal X-ray did not reveal any abnormality. The ultrasound finding of intussusception was later confirmed by the radiologist. She underwent immediate hydrostatic reduction and was discharged well.

Intussusception

“…Prompt diagnosis of intussusception is essential for effective prevention of complications such as intestinal necrosis and sepsis. 1 Ultrasonography is the method of choice to detect intussusception. A "bull's eye" or "coiled spring" lesion is seen, representing layers of the intestine within the intestine.…”

“…The classic triad of abdominal pain, palpable mass, and currant jelly stools is found in approximately 15% of cases. Intussusception in an infant is usually identified when the infant cries unprovoked while intermittently drawing their knees up to their chest to relieve the abdominal pain that recurs frequently and increases in intensity and duration over time 1,7. As the disorder progresses, the infant becomes weaker and develops additional signs and symptoms such as pallor, lethargy, and fever 1…”

“…Prompt diagnosis of intussusception is essential for effective prevention of complications such as intestinal necrosis and sepsis 1. Ultrasonography is the method of choice to detect intussusception.…”

“…1 It is the most common abdominal emergency in early childhood, particularly in children younger than 2 years of age, and is the most common cause of intestinal obstruction in children between 6 and 36 months of age. 1,2 Intussusception is more common in males than females, as males comprise roughly 70% of cases. 3 Most pediatric cases of intussusception are idiopathic but causes can include intestinal tumors, polyps, cysts, and Meckel diverticulum.…”

“…Alec Wallace, BSN, RN; Austin Friedheim, BSN, RN; and Bridget Parsh, MSN, EdD, RN, CNS respond– Intussusception is the invagination (telescoping) of the gastrointestinal tract that results from the proximal bowel being forced into the distal bowel 1. It is the most common abdominal emergency in early childhood, particularly in children younger than 2 years of age, and is the most common cause of intestinal obstruction in children between 6 and 36 months of age 1,2. Intussusception is more common in males than females, as males comprise roughly 70% of cases 3…”