Pediatric GI Emergencies: Pyloric Stenosis vs Intussusception vs Hirschsprung
Three infant GI emergencies all show up with vomiting or abnormal stool — but picking the wrong one changes your entire assessment focus. The NCLEX loves pairing a specific age with a hallmark finding, and mixing these up sends you straight to the wrong answer.
Master this comparison — play it or drill it.
Practice 34 NCLEX-style questions
Practice nowComparison
- Pyloric muscle hypertrophy
- Firstborn males, 2–6 weeks old
- Bowel telescopes (ileocolic most common)
- Peak 6–36 months
- No ganglion cells in distal colon
- Linked to Down syndrome
- ★Projectile non-bilious vomiting
- Hungry/eager to refeed
- olive-shaped RUQ mass
- ★Currant jelly stool (blood + mucus)
- Episodic colic, draws knees up
- Sausage-shaped abdominal mass
- ★Fails to pass meconium < 48 hrs
- Ribbon-like stool
- chronic constipation
- US: thickened pylorus > 3 mm
- Hypochloremic metabolic alkalosis
- US: target / donut sign
- Air/contrast enema (dx + therapeutic)
- Rectal biopsy: no ganglion cells
- Contrast enema: transition zone
- Correct fluids + lytes before surgery
- NPO + IV fluids
- Air enema reduction first-line
- NPO + IV fluids
- Watch recurrence 24–48 hr
- Bowel decompression
- NPO + IV fluids
- Monitor for enterocolitis
- Pyloromyotomy (Ramstedt)
- Surgery if enema fails or perforation
- Pull-through (resect aganglionic segment)
- Small frequent feeds post-op
- Excellent prognosis
- Return if recurrent pain or vomiting
- Ostomy care if staged repair
- Severe dehydration (sunken fontanel)
- Peritonitis signs: suspect perforation
- ★Fever, explosive diarrhea: enterocolitis
- Aspiration
- electrolyte imbalance
- Bowel ischemia / necrosis
- Enterocolitis (life-threatening)
Pyloric Stenosis
- Pyloric muscle hypertrophy
- Firstborn males, 2–6 weeks old
Intussusception
- Bowel telescopes (ileocolic most common)
- Peak 6–36 months
Pyloric Stenosis
- ★Projectile non-bilious vomiting
- Hungry/eager to refeed
- olive-shaped RUQ mass
Intussusception
- ★Currant jelly stool (blood + mucus)
- Episodic colic, draws knees up
- Sausage-shaped abdominal mass
Pyloric Stenosis
- US: thickened pylorus > 3 mm
- Hypochloremic metabolic alkalosis
Intussusception
- US: target / donut sign
- Air/contrast enema (dx + therapeutic)
Pyloric Stenosis
- Correct fluids + lytes before surgery
- NPO + IV fluids
Intussusception
- Air enema reduction first-line
- NPO + IV fluids
- Watch recurrence 24–48 hr
Pyloric Stenosis
- Pyloromyotomy (Ramstedt)
Intussusception
- Surgery if enema fails or perforation
Pyloric Stenosis
- Small frequent feeds post-op
- Excellent prognosis
Intussusception
- Return if recurrent pain or vomiting
Pyloric Stenosis
- Severe dehydration (sunken fontanel)
Intussusception
- Peritonitis signs: suspect perforation
Pyloric Stenosis
- Aspiration
- electrolyte imbalance
Intussusception
- Bowel ischemia / necrosis
★ marks the fact that sets a column apart.
Tap the column each item belongs to — jump in and play, or just watch it run.
Play full screen for XPClinical Pearl
Olive mass + projectile vomit = pyloric; currant jelly stool = intussusception; no meconium at birth = Hirschsprung.
Component Topics
Ready to master this comparison?
Get a personalized study plan built around this topic — free to try, no card needed.
Go further
- TopicHirschsprung DiseaseA newborn who hasn't passed meconium in 24-48 hours and has a distended abdomen may not just be slow to stool — the nerve cells that move stool forward may be completely absent.
- TopicIntussusceptionA previously healthy infant suddenly draws up the knees, screams inconsolably, then goes quiet — and passes "currant jelly" stool. Missing this pattern costs time the bowel…
- Guide4,852 Measles Cases, and the US Could Lose Its Elimination StatusCDC's 2026 measles count has more than doubled 2025's total, with a PAHO review due this month. What nurses do first: mask, isolate, N95, even if immune.
- GuideCDC's Vaccine Panel Lost All 3 of Its 2026 Meetings to a LawsuitCDC lists every 2026 ACIP meeting as cancelled over litigation. What the court ordered, where the appeal stands, and what nurses should do now.