Intussusception — formative SAQs

SAQ 1 — The infant with colicky screaming (10 marks, 15 minutes)

A previously well seven-month-old boy has had four hours of episodes in which he screams, goes pale and draws his knees to his chest for a few minutes, then settles into a drowsy sleep before the next episode. He has vomited twice. On examination during a quiet interval you feel a firm sausage-shaped mass in the right upper quadrant. [1]

a) What is the most likely diagnosis, and which two bedside features most strongly support it? (2 marks) [2]

b) Name the single most appropriate investigation, describe the diagnostic sign you expect, and state its approximate sensitivity. (3 marks) [5]

c) Outline your resuscitation before any attempt at reduction, including the fluid you would give for dehydration. (3 marks) [6]

d) Describe the definitive treatment you would expect to be offered, why it is preferred over the alternative, and the circumstance that would instead mandate immediate surgery. (2 marks) [3]

SAQ 2 — The older child and the vaccine question (10 marks, 15 minutes)

A four-year-old girl presents with twenty-four hours of intermittent colicky abdominal pain, vomiting and a palpable right-sided abdominal mass. Ultrasound confirms an intussusception that is not reduced by two attempts at air enema. In a separate clinic, a parent asks whether the rotavirus vaccine their younger baby is due to receive causes intussusception and whether they should delay it. [7]

a) Why is a pathological lead point a particular concern in this child, and which specific lesions would you consider? (3 marks) [7]

b) Outline the operative management now that enema reduction has failed. (3 marks) [6]

c) Explain the rotavirus vaccine and intussusception risk to the parent, and state your recommendation and its justification. (4 marks) [9]