ABSTRACT
Colicky abdominal pain with the infant characteristically ‘drawing up the legs’ is one of the first clinical signs of intus-
susception. The child will initially be well between the spasms, but will later become pale and lethargic. As intestinal obstruction develops, the vomiting will become bilious. Bright-red rectal bleeding mixed with mucus, the so-called ‘redcurrant jelly stool’, will be seen in a quarter of cases and more frequently if formal rectal examination is performed. A palpable mass is felt in the right upper quadrant or epigastrium, along with a distinguishable feeling of emptiness in the right iliac fossa (Dance’s sign). Tenderness with evidence of peritonism indicates ischemia or perforation of the intestine. Marked hemodynamic instability with depletion of the intravascular volume can be encountered in children with intussusception. Tachycardia and decreased capillary return should prompt vigorous resuscitation. The diagnosis of intussusception should always be borne in mind when dealing with a child with shock of unknown cause.
