The initial symptoms of agitation, abdominal pain, and occasional leg pulling may be consistent with gastroenteritis
Differential Diagnosis
Gastroenteritis: The initial symptoms of agitation, abdominal pain, and occasional leg pulling may be consistent with gastroenteritis, especially if the patient has recently been exposed to bacteria that cause stomach flu. Due to gastrointestinal inflammation, gastroenteritis can produce rapid episodes of abdominal pain. The lack of symptoms such as nausea, vomiting, diarrhea, fever, and other gastrointestinal symptoms reduces the likelihood of gastroenteritis.
Toddler’s diarrhea: Toddler’s diarrhea, also known as functional diarrhea or chronic nonspecific diarrhea of childhood, is a common cause of chronic diarrhea in toddlers and preschool-age children. Children with toddler’s diarrhea pass four or more watery or loose stools daily without any other symptoms, and are generally growing well, gaining weight, and healthy. While toddler’s diarrhea can cause irritability and discomfort, the sudden onset of severe pain and the physical examination findings such as the Dance sign are not typical of this condition.
Colic: Colic is an attack of crying and what appears to be abdominal pain in young infancy. It’s relatively common in infants. (Felman, A. 2028). While colic can produce irritability and screaming, the age of the infant (16 months) and the sudden onset of severe pain and leg-pulling are not typical of colic. Colic tends to be more continuous and less severe.
Most likely diagnosis:
Based on the provided clinical information, intussusception emerges as the primary diagnosis due to the following key features:
As stated by the mother, the child’s presentation of sudden and severe pain is a crucial signal. Intussusception is well-known for generating severe, colicky abdominal pain.
The description of the child’s symptoms, especially the rapid onset of pain followed by periods of calm in between, is consistent with the intermittent nature of intussusception episodes.
Child pulls legs to chest during abdominal discomfort due to intussusception, is a classic response to abdominal discomfort.
Dance sign: Intussusception is characterized by an empty or scaphoid right lower abdomen, resulting from intestine telescoping and proximally retracting the intussuscepted portion.
Patient’s age of 16 months falls within the common range of intussusception observed in infants and young children, between 3 months and 3 years.
The absence of fever, vomiting, diarrhea, and other notable gastrointestinal symptoms distinguishes intussusception from illnesses such as gastroenteritis or appendicitis.
While this diagnosis needs to be confirmed through diagnostic imaging (typically abdominal ultrasound) and managed as an inpatient emergency, the presented information supports intussusception as the most likely explanation for the child’s symptoms.
Pathophysiology
Intussusception is a serious condition where the intestine slides into an adjacent part, blocking food and fluid flow. This can lead to infection, tissue death, or perforation. Intussusception is most common in children under 3, and most cases are caused by underlying medical conditions. In adults, intussusception is rare, and surgery is often required to correct the problem. The cause of most cases in children remains unknown.
Management:
Immediately refer child to hospital emergency department or pediatric specialist for evaluation and management.
Diagnostic imaging is crucial for intussusception diagnosis, with abdominal ultrasound being the preferred modality for visualizing intestine telescoping.
Once the diagnosis has been made, a pediatric surgeon or gastroenterologist who has treated intussusception should be consulted. Based on the child’s condition, these specialists will choose the best course of treatment.
An operation is required for intussusception that cannot resolve with a barium enema or is too ill for diagnostic procedures. Under anesthesia, a surgeon makes an incision in the child’s abdomen, locates the intussusception, and pushes affected sections back into place. The intestine is examined for damage, and if damaged, sections are removed. If small damage is present, healthy sections are sewn back together, while large injuries may require significant removal.
Parents should be informed about condition, procedure, complications, and discharge signs.
References:
Boston Children’s Hospital. (2023). Intussusception | http://track.smtpsendemail.com/9064971/c?p=QPLkclXLCO–poXp857R7C191pA5ICI1LINfUIgGHdlL1uYDzgv_GaBgwwIxUzZEfZTL5bfGb4euE6tov61gs3fFivVcrhekRCEbrXeI70lTiMi8GWPWVq9gDr-e81qg-IHUW4n882ahaYv5rlJOQqksN_OUIpokFwReXr6aEiC_zcAqI1hPxySEayn8RVWZ25ZclocrNSKuzuZ8Dj5Pcg==
Chahine, A. A., MD. (2018). Intussusception Treatment & Management: approach considerations, nonoperative reduction, surgical reduction. http://track.smtpsendemail.com/9064971/c?p=_TYO7ZWexfGOSWSNbIKuBJhTZB-yhlCVhSfLs-8tc0jo4ktad-KNeRI30jnscd4_IS7G93miozKWlBiKsumlPWqFvu7py5XyeMzQqyRHPYnikewCNgwjjb5gCvOLZFAHEnIIO3Bu9QRQ3zrtvqjkQovaMBfVBsX8Ay-A4snd2b78TNWHb-u__xPOUdbxqxWIKe5jb_GvllNnRtoj8EogPQ==
Felman, A. (2019b, December 14). Everything you need to know about colic. http://track.smtpsendemail.com/9064971/c?p=hkImj_3DCPHrnvwxXGMvpMoL7MyBKCOsKjIU7C2GUCevr7h9u8RrxvinafMcmrLZmpgq_sTyytTLBj8tNhJc7R3DCx4GNReabd1kuhvdbzCNVmjT6rfCSJBEuQ13UtgUlqNeHK7ob0gAP4kh4WosjxyEg6pVM8ie-jfELVFwE6VI3P9Eklg-2Xu0iwP2smuqwsIvi32DudwM6aMRsAesBw==
Mayo Clinic. (2023, January 5). Intussusception – Symptoms & causes -Mayo Clinic. http://track.smtpsendemail.com/9064971/c?p=7oO2XsDEu2c2qWClKa1hAlrpOyW2EFR2OMXTuPg_mUie20s-6eviage8zAp0LAfiGsYmBYoiHogflbXiIOOu1vrlmrFbevABTjcFDp8MNiJ-rFuyKBce6J4qrdGGOaHvB9vIY4oBLLHEpvqga0F-jydNhedDGFplCAYJLJDUHjkzUJC4yX5uLhpGDoRC1X3lFXXEB1MIsW2lGBl3ChSVwZkk35DL2zxseh5_4BU3F2vyrlFG9SURVx8f1jRk3Vsa
Professional, C. C. M. (n.d.-h). Intussusception. Cleveland Clinic. http://track.smtpsendemail.com/9064971/c?p=-ltrUnO9r3A-zy47Wo9-w0xq7MB8hwQ5OVmAglQd0m5Bld7ImVqLq7ScZqMgXpDzn9VbnMA5tyRKgB8A0_sq3TAuJxduM136vZPkCvmWcCWhduUCfMyzkqMEs6t8d5qCvaPkWMGo9e-3T5JnDbrwzSt_6ZeUYRZzCzrDtPF8EGHjbNY3A4p3jPJb16R4Hqye1in2E2M4MuuXJ_4q01DvOhiC4o5agHE3tJrT4nkXeLY=
National Institute of Diabetes and Digestive and Kidney Diseases (2022). Symptoms & Causes of Chronic Diarrhea in Children. http://track.smtpsendemail.com/9064971/c?p=lKW6DA6UJ-5VY7eoqKtbHx1xN3MovsxPCxOFxrG6INrcLzKYsHBhf6JsThSf2WMwL5SnFFKGk3Z4JWfqn2Ksm0GG0SE2Bace3idDSCitVTjL1Zq-y02jJF3hOu8xrncCP3_Yw_DibsOqbGNOIwuTz1USw-aaLxMDv-q81TSWctwy_sAvXcfYvrHqHaGZRNXQ7AwNkSRHgNlVJxdrO_g4LDqw0PixorNXTeVAq8vgCHJFn8a2GHmmWtkIIsBDSy6nUOGeQBdPgMlI4UQxe58Kdw==
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