Health

In which patients should the diagnosis of intussusception be considered?  In the classic description of intussusception, a child age 3 months to 3 years presents with the legs intermittently drawn up to the chest while crying, bloody stools, vomiting, and a sausage-shaped abdominal mass. Unfortunately, the classic presentation is not common, so a high index …

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What is the “classic triad” of intussusception? Does it occur in most patients?  Intussusception occurs when a portion of the bowel, usually the distal ileum, telescopes into an adjacent segment of bowel. This effectively leads to intestinal obstruction followed by venous congestion and, finally, arterial insufficiency. The classic triad of pain, currant-jelly stool, and abdominal …

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Is magnetic resonance imaging (MRI) useful in the evaluation of children with suspected appendicitis?  MRI has been suggested as an alternative to CT in children suspected of appendicitis with an inconclusive ultrasound to avoid the detrimental effects of radiation. It has been shown that the sensitivity of MRI without contrast in diagnosing appendicitis has been …

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Is oral and IV contrast necessary in CT for the evaluation of children with suspected appendicitis?  CT for appendicitis requires IV contrast to detect inflammation due to appendicitis or various other causes, but oral contrast is not necessary for the diagnosis of appendicitis. There is an increasing body of evidence that shows that there is …

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Role of CT and USG in suspected appendicitis What are the test characteristics of ultrasound and computed tomography (CT) for the evaluation of children with suspected appendicitis?  Ultrasonography is beneficial because it does not expose the child to ionizing radiation. However, it is operator dependent and may have limited use in obese children. Ultrasound can …

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What are some of the pitfalls in diagnosing appendicitis?  The presentation of a child with appendicitis may not be “textbook.” The absence of fever or anorexia, pain in an atypical location, the presence of diarrhea, prolonged symptoms, and normal laboratory values can occur in patients with appendicitis. An appendix that is located in the lateral …

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What is the typical presentation of appendicitis in children?  Classically, periumbilical abdominal pain precedes the onset of vomiting and is associated with low-grade fever, nausea/vomiting, and anorexia. As the inflammation of the appendix advances and touches the adjacent peritoneum, the pain localizes to the right lower quadrant at McBurney’s point. However, the clinical course often …

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