Intussusception

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Imagine yourself confronted with a case of intussusception….(I5)—> too lazy to type this word everytime,

Personally, its tricky.
Its not as easy as we think it is.
Being a doctor requires us to have a high degree of suspicion….of a lot of diseases….. Keep your head open to many possibilities…. Just in case.

Contrary to popular belief among undergraduates…. Red currant jelly like stool is always mentioned together with intussusception which indirectly prompts us to think that without this sign, we cant diagnose I5.But thats a wrong mindset..what kinda shocked me today is that… This red currant jelly sign is in fact a late sign and happens after 18hours after the onset of I5!!!!

The earlier signs….. As the doctor mentioned…is paroxysmal attacks of colicky abdominal pain…. The baby cries…..then due to exhaustion…he sleeps… The he cries…and the cycle continues..
2. Refuse feeding
3.????? I forgot.Haha.. Is it non bilious vomiting….( due to traction on the omentum)?

So when a mother comes complaining to you these signs….please…..start examination…… Dont take it lightly..you will probably find a mass in the rt ilac fossa or hypochondrium and the part below is empty( dance sign)

Do ultrasound too…and check out the target sign…wuuuhuu!( tepu dha)

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Hmm…. I read about intussusception further from emedicine…
Previously the doctor mentioned that henoch schoenlein purpura(HSP) presents with abdominal pain and may also give out the target sign…

Guess what i found???
HSP CAN COMPLICATE BY INTUSSUSCPETION DUE TO SUBMUCOSAL HEMATOMA WHICH MAY ACT AS A LEADING POINT.

wow isnt that an interesting find.. NO??? btw..it is to me….
Actually it isnt as simple as we want it to be…. IF THE ABDOMINAL PAIN PRECEDES THE SKIN MANIFESTATION….THEN..IN THIS STATE..IT IS ACTUALLY HARD TO DDX WITH OTHER DISEASES…

Ok2… My golden question is
HOW CAN YOU DDX BETWEEN HSP ALONE OR WITH HSP COMPLICATED BY INTUSSUSCEPTION??

Of course…search for other symptoms of hsp….such as the petechiae and the purpura…. The kidney manifestation…( may mimic PSGN)
In hsp, the age is around 2-5 yo.
Also…do plain radiography…to rule out intestinal obstruction…..that sets the difference…
Again,.plz dont sit and wait for your patient do poop out red jelly to finally diagnose I5..

Btw, hemophilia can also complicate by I5 due to submucosal hematoma!

There is ….in fact…a lot of ddx for I5….

What shocked me too is that electrolyte imbalance can also cause I5!!!

Hhuhhhh.

O allah please make it easy for us.

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