I would appreciate hearing how members of the list-serve manage infants in whom there is concern of possible intussusception having occurred but in whom signs, symptoms and plain radiographic findings are normal or have returned to normal. The question(s) pertain to how aggressive we should be in pursuing further diagnostic imaging such as US or air-contrast BE and observation at home or in hospital. I think it would be most helpful to present a case scenario and have members respond with some orientation to the scenario, though more broad management suggestions beyond the scenario are welcome. Responses may be to me directly or to the list; if more than a few are received, I will summarize and report the results to the list.
The scenario is of a 5 month previously healthy infant who has an episode of emesis and appears to the pediatrician in her office to be lethargic and to have a tender abdomen. The infant is referred to the ED and, in the 4 hours prior to being seen, has no further emesis, feeds normally, has a normal stool, and is alert and interactive. When seen the infant is normally alert, has a normal exam, specifically a normal abdominal exam without tenderness or mass and a normal rectal exam with negative hemoccult. She feeds vigorously and without emesis. Abdominal films are read as normal by the radiologist. The parents are perceived as reliable and able to return if necessary: What would you do next:
1. Observe the infant at home with written parameters for return (ie, lethargy, apparent abd pain, bloody stool, emesis).
2. Perform air-contrast BE
3. Perform US
4. Admit for observation
5. Punt to surgery and let them sweat it
Answers may include more than one or a sequence of choices.
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