Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with sudden onset of intermittent, severe, colicky abdominal pain associated with inconsolable crying and drawing of knees to the chest. Episodes are followed by periods of lethargy or apparent well-being. Associated symptoms include non-bilious or bilious vomiting, and passage of "currant jelly" stools. No recent history of fever or diarrhea.
Clinical Examination Findings
Abdominal examination reveals a palpable, sausage-shaped mass, typically located in the right upper quadrant or epigastrium. The right lower quadrant may feel empty (Dance sign). Bowel sounds may be hyperactive or diminished depending on the duration of obstruction. Rectal examination confirms the presence of blood or mucus on the examining finger. Patient appears distressed during episodes, with periods of lethargy between crises.
Treatment Protocol
Initial management includes NPO status, IV fluid resuscitation, and nasogastric decompression if vomiting is persistent. Diagnostic and therapeutic air or contrast enema is indicated for stable patients without signs of peritonitis or perforation. If reduction is unsuccessful or clinical signs of bowel ischemia/perforation are present, emergent surgical consultation for manual reduction or resection is required.