Intussusception

A 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 doesn't have.

Intussusception occurs when one segment of bowel telescopes into an adjacent segment, most commonly at the ileocecal junction. It is the most common cause of intestinal obstruction in children 3 months to 6 years, with peak incidence between 5 and 10 months. The hallmark triad is sudden episodic colicky abdominal pain (the infant draws knees to chest and screams, then becomes calm between episodes), a palpable sausage-shaped mass in the right upper quadrant, and currant jelly stools — a mix of blood and mucus that signals mucosal ischemia. Currant jelly stool is a late sign; do not wait for it to suspect the diagnosis. A barium or air-contrast enema is both diagnostic and often therapeutic, reducing the telescoped segment by hydrostatic or pneumatic pressure. If enema reduction fails or perforation is suspected, surgical intervention is required. Nursing priorities include monitoring for signs of perforation (fever, increasing abdominal rigidity, shock), maintaining NPO status, providing IV fluid resuscitation, and keeping a nasogastric tube in place if ordered for decompression. Post-reduction, monitor for recurrence within the first 24–72 hours — passage of a normal brown stool is the most reliable indicator of successful reduction.

Key Distinctions

Don't confuse intussusception (episodic pain with pain-free intervals, sausage-shaped mass, currant jelly stool) with pyloric stenosis (projectile non-bilious vomiting, olive-shaped mass, no bloody stool). Students mix up the masses: sausage-shaped = intussusception (RUQ), olive-shaped = pyloric stenosis (right epigastric area). Currant jelly stool is specific to intussusception — it does not appear in Hirschsprung disease, which presents with ribbon-like stool and absent meconium passage.

Clinical Pearl

Sausage mass + currant jelly + knees to chest = intussusception. Think "the bowel swallowed itself" — and a normal brown stool after reduction means it let go.