Clinical Features and Epidemiology:
- Age: seen mainly in infants <1 year. Note can also less commonly occur in older children.
- Colicky abdominal pain: pain that is coming and going. When pain is present the infant is inconsolable. Often crying/screaming and flexing their legs up during episodes.
- Associated symptoms: there may or may not be lethargy, dehydration, vomiting, recent infection e.g. cough/gastroenteritis, blood/mucus in stool (red currant jelly stool – usually a later sign), or features of obstruction (vomits, lack of flatulence and stool).
- On examination: there maybe signs of dehydration and a mass within the abdomen.
Differentials:
- Mesenteric adenitis: presents with abdominal pain that can be fluctuating in nature. Usually involves a history of pain moving around abdomen. A viral cause e.g. sore throat may or may not be found.
- Gastroenteritis: presents with abdominal pain, vomiting, and diarrhoea. Pain is diffuse and fluctuating.
- Constipation: lack of regular bowel movement and may be associated with abdominal pain and straining in infants. Pain is fluctuating in nature and infant is often consolable.
Who to refer:
- Any infant who has the above clinical features.
- Any infant where the clinician has uncertainty or concern over symptoms.
How to refer:
NHS Lothian:
- Bleep the on call paediatric surgery FY via RHCYP switchboard and send the infant to RHCYP A&E. Clinical details can be discussed over the phone.
- Keep the patient fasted until they are assessed in hospital
NHS Fife, Tayside, and Borders:
- Please send to local ED for assessment and resuscitation and patients can be referred on to RHCYP if required.
Advice to parents:
- What to expect when arriving at the hospital – re-examination, taking bloods, and ultrasound if intussusception is suspected.
