A 2-year-old with acute abdominal pain and bloody diarrhea most likely has which diagnosis?

A 2-year-old with acute abdominal pain and bloody diarrhea most likely has which diagnosis?

• A. Pyloric Stenosis
• B. Crohn Disease
• C. Intussusception
• D. Hirschsprung Disease

Answer: (C)

Intermittent severe abdominal pain in a young child with bloody stools points most strongly to intussusception. In this condition, a segment of bowel slides into an adjacent segment, causing sudden, crampy pain that comes and goes as the telescopeing segment repeatedly invaginates and reduces. The compromised blood flow and mucosal irritation lead to mucous and blood in the stool, often described as a "currant jelly" stool. The age fits well for this diagnosis, and a palpable sausage-shaped mass may be felt in the abdomen. Ultrasound is the best test and typically shows a target or doughnut sign. Treatment is usually an air (or contrast) enema that both diagnoses and reduces the intussusception, with surgery reserved for unclear perfusion or failed nonoperative reduction. If not treated promptly, it can progress to bowel ischemia, perforation, and peritonitis. Pyloric stenosis would present with projectile nonbilious vomiting in younger infants. Crohn disease can cause pain and bloody stools but tends to be more chronic and not the abrupt, episodic pattern seen here. Hirschsprung disease typically shows delayed meconium passage and chronic constipation rather than acute bloody diarrhea.

Intermittent severe abdominal pain in a young child with bloody stools points most strongly to intussusception. In this condition, a segment of bowel slides into an adjacent segment, causing sudden, crampy pain that comes and goes as the telescopeing segment repeatedly invaginates and reduces. The compromised blood flow and mucosal irritation lead to mucous and blood in the stool, often described as a "currant jelly" stool. The age fits well for this diagnosis, and a palpable sausage-shaped mass may be felt in the abdomen. Ultrasound is the best test and typically shows a target or doughnut sign. Treatment is usually an air (or contrast) enema that both diagnoses and reduces the intussusception, with surgery reserved for unclear perfusion or failed nonoperative reduction. If not treated promptly, it can progress to bowel ischemia, perforation, and peritonitis.

Pyloric stenosis would present with projectile nonbilious vomiting in younger infants. Crohn disease can cause pain and bloody stools but tends to be more chronic and not the abrupt, episodic pattern seen here. Hirschsprung disease typically shows delayed meconium passage and chronic constipation rather than acute bloody diarrhea.