Blood, mucous in stools need urgent attention

Bose is a 13-month-old female toddler who is being taken care of by grandma due to the busy nature of her mom’s job. The grandma is a very observant woman who pays attention to little details.

She had rushed the toddler to the hospital one morning after an uneventful night of bouts of diarrhoea, repeated vomiting and blood in the stool.

Bose was my first patient for the day. After taking the medical history and examining the child, I placed her on admission and commenced the drips. Her blood sample was also taken for investigations.

I did not waste time making impressions of acute abdomen pain in order to rule out intussusception – a medical emergency that needs the attention of a paediatric surgeon.

The paediatric surgeon was called, the baby was operated on and she was fine within 72 hours after the surgery. The surgeon’s findings showed that one part of her intestine had entered the other.

The surgeon also found that the appendix was inflamed; consequently, he simultaneously removed it – a surgery called incidental appendicectomy.

After the surgery, the surgeon congratulated the parents and explained to them that the surgery was fine. On a lighter mood, he teased the parents that they would pay extra for the appendectomy, since it was an additional surgery.

He informed them that the child no longer carries an appendix and that they should not allow her to be misdiagnosed of appendicitis in the future. Bose is fine now and she has grown from a toddler to the pre-school age.

Intussusception is the invagination of a proximal segment of the bowel (intestine) into the distal bowel (intestinal) lumen. The commonest occurrence is a segment of ileum moving into the colon through the ileo-caecal valve.

It may occur at any age, but it commonly occurs in the two-month to two-year age groups. It also occurs in adults.

Causes

The causes of intussusceptions are not fully known, although some viral and bacterial infections of the intestine may possibly contribute to intussusceptions in infancy.

Signs and symptoms

The child appears to have intermittent pain which is colicky, severe and may be associated with the child drawing up the legs. Pain occurs two to three times per hour and may increase over the next 12-24 hours

During these episodes of crying, the child may look pale, compared to many other causes of infant crying which are associated with facial redness rather than paleness.

Vomiting is usually a prominent feature, while bloody and mucous stools (like classic red currant jelly stool) are also a sign.

Weakness, (lethargy) and diarrhoea are also common symptoms.

Examination

The doctor looks for the following signs to confirm his suspicion of intussusceptions: pallor, lethargy, abdominal swelling, and distended abdomen later in the course of the illness.

Bloody stool/occult blood is positive, rectal examination is done but may be unnecessary if good evidence of intussusceptions is present.

Investigations

The doctor requests for abdominal X-rays, abdominal ultrasound scan, series of blood tests for infections, for kidney status, blood glucose, blood groups/levels, as well as urine tests are among the numerous tests to be done.

Treatment

Treatment is surgery; this is usually done by a paediatric or general surgeon. The use of air enema is diagnostic and therapeutic.

Prevention

There is no particular prevention, since the exact cause is not known.

In conclusion, blood in stools of children with diarhoea is called dysentary and is mainly caused by bacteria.

When next a child is crying, rolling on the floor, weak, pale, gripping in pain, vomiting, and passing stools with blood and mucous, seek medical attention immediately, as it could be intussusceptions.

PUNCH.