Intussusception vs Volvulus and pyloric stenosis age patterns
How to tell Intussusception and Volvulus and pyloric stenosis age patterns apart when a board question makes them look alike.
Intussusception is episodic pain/currant jelly/target; volvulus is bilious malrotation emergency; pyloric stenosis is nonbilious projectile vomiting in young infant.
Side by side
Intussusception causes episodic severe abdominal pain, drawing up legs, currant jelly stool, sausage-shaped mass, and target sign in infants/toddlers; lead points include Meckel diverticulum, HSP, and lymphoma, especially in older children.
Volvulus causes bilious vomiting and surgical obstruction often with malrotation; pyloric stenosis causes projectile nonbilious vomiting at 3-6 weeks with olive mass and hypochloremic hypokalemic metabolic alkalosis.
Intussusception classically causes episodic severe abdominal pain, drawing up legs, currant jelly stool, sausage-shaped mass, and target sign in infants/toddlers.
Volvulus causes bilious vomiting and surgical obstruction often with malrotation; pyloric stenosis causes projectile nonbilious vomiting at 2-8 weeks.
Ultrasound target sign; postviral lymphoid hyperplasia and rotavirus vaccine association can precede intussusception. Older child suggests a pathologic lead point such as Meckel, HSP, or lymphoma.
Volvulus: bilious emesis and malrotation. Pyloric stenosis: 3-6 weeks, olive mass, nonbilious projectile vomiting, hypochloremic hypokalemic metabolic alkalosis.
The repair move
Before naming the answer, force the stem through the separator: Intussusception is episodic pain/currant jelly/target; volvulus is bilious malrotation emergency; pyloric stenosis is nonbilious projectile vomiting in young infant.
Try a free question
CoreAn 8-month-old previously healthy boy has had 6 hours of episodes of severe abdominal pain causing him to draw up his legs and cry, followed by periods of relative quiet. He has passed 'currant jelly' (mucus + blood) stool. Abdominal exam reveals a palpable 'sausage-shaped' mass in the right upper quadrant. Ultrasound shows a 'target sign'. Which condition is most likely?
Show answer and explanation
Answer: A. INTUSSUSCEPTION. Intussusception is telescoping of one segment of bowel into another, classically ILEOCOLIC at the ileocecal valve. Most common in infants 6 months to 2 years. Classic features: episodic severe colicky abdominal pain (drawing up legs), 'currant jelly' stool (mucus + blood from compromised bowel), sausage-shaped abdominal mass. Diagnose with abdominal ultrasound ('target sign' or 'doughnut sign'). REDUCE with air or contrast enema (also therapeutic). Surgical reduction if enema fails or perforation present. Post-viral lymphoid hyperplasia is a common lead point; pathologic lead points (Meckel diverticulum, HSP-associated bowel wall edema, lymphoma) more common in older children.
Why the other choices are tempting
- B. Volvulus is bilious vomiting with malrotation, more acute surgical emergency.
- C. Pyloric stenosis is 3-6 weeks old with projectile NON-bilious vomiting.
- D. Acute appendicitis is in older children with right lower quadrant pain.
- E. Hirschsprung disease has chronic constipation from birth.
Flashcards
Tap a card to flip it.
What clue supports Intussusception?
Choose Intussusception when the stem gives this pattern: Intussusception classically causes episodic severe abdominal pain, drawing up legs, currant jelly stool, sausage-shaped mass, and target sign in infants/toddlers.
What clue supports Volvulus and pyloric stenosis age patterns?
Choose Volvulus and pyloric stenosis age patterns when the stem gives this contrasting pattern: Volvulus causes bilious vomiting and surgical obstruction often with malrotation; pyloric stenosis causes projectile nonbilious vomiting at 2-8 weeks.
Quick answers
What is the fastest way to tell Intussusception from Volvulus and pyloric stenosis age patterns?
Intussusception is episodic pain/currant jelly/target; volvulus is bilious malrotation emergency; pyloric stenosis is nonbilious projectile vomiting in young infant.
What is the key clue for Intussusception?
Intussusception causes episodic severe abdominal pain, drawing up legs, currant jelly stool, sausage-shaped mass, and target sign in infants/toddlers; lead points include Meckel diverticulum, HSP, and lymphoma, especially in older children.
What is the key clue for Volvulus and pyloric stenosis age patterns?
Volvulus causes bilious vomiting and surgical obstruction often with malrotation; pyloric stenosis causes projectile nonbilious vomiting at 3-6 weeks with olive mass and hypochloremic hypokalemic metabolic alkalosis.