This is an illustrative teaching case built from typical features. It does not describe a real patient.
Presentation
A previously well nine-month-old is brought in with episodes of inconsolable crying, drawing the legs up, every 15–20 minutes. Between episodes the infant is pale and lethargic. There have been two episodes of vomiting. The classic “redcurrant jelly” stool is absent — as it is in many cases.
Imaging
Abdominal ultrasound is the investigation of choice, with high sensitivity and specificity and no radiation. In the right abdomen, a mass with concentric rings — the “target” or “doughnut” sign in transverse section — confirms ileocolic intussusception. Colour Doppler shows preserved blood flow, and there is no free fluid suggesting perforation.
Ultrasound findings to report:
- Location and size of the intussusception
- Blood flow in the bowel wall
- Trapped fluid or lymph nodes within it
- Free fluid or signs of perforation
Management
After resuscitation and surgical review, image-guided enema reduction is performed using air or saline. Contraindications include peritonitis, perforation and haemodynamic instability. Reduction succeeds in the majority of cases; failure or complications need operative management.
“Intermittent pain with a pale, quiet child between episodes should prompt an ultrasound.”
Learning points
Intussusception is most common between six months and three years. The triad of pain, vomiting and bloody stool is present in only a minority, so a low threshold for ultrasound is essential.
This article is for education only and does not replace clinical judgement or local guidelines.
