Before taking any medical measures, a clear diagnosis must be made as soon as possible unless emergency treatment is required.
If you suspect intussusception and choose to do auxiliary examinations, textbooks used to usually talk about using barium meals.
This was because at that time there was a shortage of B-ultrasound machines and CT machines, and only X-ray machines were relatively abundant.
Advances in medical technology have given doctors more options, thereby eliminating inappropriate examination methods.
For example, barium meal is actually not suitable because intussusception causes intestinal obstruction, and giving barium meal will only aggravate the intestinal obstruction.
CT has radiation, so ultrasound is the preferred choice as it is quick and convenient.
There is an ultrasound room in the emergency department of Seoul Children's Hospital. It is fastest to take the child there for an ultrasound.
Several people carried the child to the ultrasound room. Because the child's condition was urgent, they explained to the other children and parents in line and went to the front of the line for the examination.
There are four typical symptoms of intussusception. One is paroxysmal abdominal pain, which manifests as the child crying and then quieting down. The second is vomiting, which this child has. The third is jam-like stool, which is bloody mucosal stool, which this patient does not have. The fourth is a sausage-like mass, which this patient does have.
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Only two of the four symptoms can only be called preliminary suspicion, and instrument-assisted examination is necessary. Vomiting and sausage-like masses are signs of intestinal obstruction, not necessarily caused by intussusception. For example, ascariasis is another common childhood disease in clinical practice. Ascaris masses can also cause intestinal obstruction, but the age of onset is generally older children, but it is true that this disease usually does not have bloody stools. If the doctor touches the mass, the surface of the ascaris mass is cord-like. That being said, it depends on the feeling of the doctor's hand. Every doctor has a different touch, just like Schrödinger's cat, it is hard to explain.
B-ultrasound examination is much more intuitive. According to the principle of intussusception, B-ultrasound can detect a phenomenon of a large ring enclosing a small ring, which is called the concentric circle sign.
The clinicians stood behind the ultrasound doctor and watched. Two low-echo masses appeared on the screen of the instrument, nested together, with a high-echo band in the middle.
"It should be intussusception." Shouer's ultrasound doctor is very knowledgeable about this disease and is very familiar with it. He can determine it with just a few glances.
Just in case, scan the child's appendix again. Acute appendicitis is also a very common and easily overlooked acute abdomen for infants and young children. The appendix is connected to the cecum, so it is close to the location where the disease occurs, so it is necessary to distinguish and identify it.
There is no problem after scanning the child's appendix. If you want to be more cautious, you can do a CT scan. CT is more time-consuming, and there is no need to do another CT scan if the test results are relatively clear.
A good doctor can save patients and their families money.
The focus is now on the next medical strategy.
If the intussusception is serious and causes intestinal necrosis, surgery is required immediately to remove the dead intestine and perform anastomosis. Inform the emergency nurse to call the pediatric general surgeon in the inpatient department to come down and see the child so that a decision can be made.
It just so happens that today is the first day for all employees to return to the hospital, and it is the busiest time for everyone. Many surgeries that were delayed during the holidays were scheduled and rushed to be performed, and the surgery schedule for the day before was fully booked. It is said that all the pediatric general surgeons have gone to the operating room, and it will take some time to notify the doctors to come down from the operating room.
Before the inpatient department staff came down to take the patient away, the doctor in charge continued to serve as the emergency doctor.
Seeing that the child's condition was getting worse, Xie Wanying suggested: "Why don't we seize this time and try to reposition the child, Doctor Duan."
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