Which one of the following is the LEAST consistent with a diagnosis of intussusception?
A. Intermittent colicky abdominal pain, interspersed with symptom-free periodsB. Grossly normal appearing stool
C. Normal plain films of the abdomen
D. Previously healthy 9-year-old child
Answer .D. Previously healthy 9-year-old child
Intermittent
colicky pain, occurring about every 20 min, is the typical history for
intussusception. Because the child looks and acts completely normal between
pain episodes, the diagnosis is often overlooked. The stool commonly appears
grossly normal until ischemia progresses and “currant jelly” stools
develop. Although a mass effect in the right upper quadrant on x-ray or
palpation is suggestive of the diagnosis, up to one-third of plain films are
normal. The usual age range for presentation is between 3 months and 6 years.
