Telescope Tommy — Intussusception
Currant jelly stool, sausage-shaped mass, sudden inconsolable crying — think emergency, not colic
Tommy, 10 months old, suddenly screams and pulls his legs up to his belly, then minutes later plays happily as if nothing happened. This happens three more times before his mother brings him in.
Tommy is a healthy toddler who suddenly develops episodes of severe abdominal pain, drawing his knees to his chest and screaming, then acting normal between episodes. One segment of bowel telescopes into another, cutting off blood flow. A palpable sausage-shaped abdominal mass and red, currant-jelly stool (blood mixed with mucus) are classic late signs. An air or contrast enema is both diagnostic and often therapeutic; surgery is needed if it fails or perforation occurs.
Read Telescope Tommy's full story →The story arc
The setup
Tommy has been a healthy, thriving baby with no prior GI problems until today's sudden, intermittent crying spells.
The turn
The episodes of drawing his knees up and screaming come every 15–20 minutes, and between them he seems oddly quiet and lethargic rather than fully normal.
The crisis
His mother notices a red, jelly-like stool in his diaper, and the nurse palpates a sausage-shaped mass in his right upper quadrant.
The save
The nurse keeps Tommy NPO, starts IV fluids, and prepares him for an emergent air or contrast enema, which is diagnostic and frequently reduces the intussusception without surgery.
NCLEX study section — Intussusception
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Pediatrics
Take this chapter into practice questions on the same topic.