Intussusception — formative SAQs

SAQ 1 — The infant with colicky screaming (10 marks, 15 minutes)

A previously well seven-month-old boy has had four hours of episodes in which he screams, goes pale and draws his knees to his chest for a few minutes, then settles into a drowsy sleep before the next episode. He has vomited twice. On examination during a quiet interval you feel a firm sausage-shaped mass in the right upper quadrant. ^[1]

a) What is the most likely diagnosis, and which two bedside features most strongly support it? (2 marks) ^[2]

b) Name the single most appropriate investigation, describe the diagnostic sign you expect, and state its approximate sensitivity. (3 marks) ^[5]

c) Outline your resuscitation before any attempt at reduction, including the fluid you would give for dehydration. (3 marks) ^[6]

d) Describe the definitive treatment you would expect to be offered, why it is preferred over the alternative, and the circumstance that would instead mandate immediate surgery. (2 marks) ^[3]