From the Guidelines
The correct answer is D, as bleeding is indeed a common presentation of intussusception in children, highlighting the importance of prompt recognition and management of this condition. Intussusception, which occurs when one segment of the intestine telescopes into an adjacent segment, typically presents with symptoms that can include bloody stools, often described as "currant jelly" in children, due to venous congestion and mucosal damage as the intestinal wall becomes compressed 1. This condition is significant because it can lead to severe complications if not addressed promptly.
While other options mention potential causes of gastrointestinal issues in children, such as anal fissures and Meckel's diverticulum, they do not accurately represent the most common presentation of intussusception. Anal fissures, for instance, are common in children but are not typically associated with the significant gastrointestinal bleeding seen in intussusception. A clear nasogastric aspirate does not definitively rule out upper GI bleeding, as intermittent bleeding may be missed, making option B incorrect. Meckel's diverticulum, contrary to option C, can indeed cause significant bleeding, especially when it contains ectopic gastric mucosa that secretes acid, leading to ulceration and potential massive hemorrhage, but it is not the most common cause of bleeding in the context of intussusception.
Key points to consider in the management of gastrointestinal bleeding in children include:
- Recognizing the signs and symptoms of intussusception, such as abdominal pain, vomiting, and the passage of "currant jelly" stool.
- Understanding that a clear nasogastric aspirate does not rule out upper GI bleeding.
- Being aware that Meckel's diverticulum can cause significant bleeding but is not the leading cause of such symptoms in intussusception.
- Promptly diagnosing and managing intussusception to prevent complications, as highlighted by the potential for malignancies and other serious conditions discussed in the context of Peutz-Jeghers syndrome 1.
From the Research
Gastrointestinal Bleeding in Children
The correct answer is:
- D. Bleeding is the most common presentation of intussusception
Evidence for the Correct Answer
- According to the study 2, rectal bleeding is the most common clinical feature of intussusception, presenting in 81% of cases.
- The study 3 also mentions that the classical triad of symptoms, including abdominal pain, vomiting, and bleeding, is evident at the time of presentation in only about 20% of cases, but bleeding is a common presenting feature.
Evidence Against the Other Options
- Option A: Anal fissure is not mentioned as the leading cause of gastrointestinal bleeding in children in any of the provided studies.
- Option B: A clear nasogastric aspirate does not rule out upper GI bleeding, but this is not directly addressed in the provided studies.
- Option C: Meckel's diverticulum can be a cause of massive bleeding, as mentioned in the study 4, which states that life-threatening complications of Meckel's diverticulum include bleeding. Therefore, it is not correct to say that Meckel's diverticulum is seldom a cause of massive bleeding.