Diagnosis: Intussusception
The diagnosis is intussusception, as severe abdominal pain, nausea, vomiting, and diarrhea with mucus in a 4-12 year old female are characteristic of this condition, where one bowel segment telescopes into another. 1
Clinical Reasoning
The presentation of severe abdominal pain combined with mucoid diarrhea is the key distinguishing feature here. The presence of mucus in the stool represents an early stage of intussusception, occurring before progression to the classic "currant jelly" bloody stools that develop as bowel ischemia advances 1. This clinical picture differs significantly from simple viral gastroenteritis, which typically presents with milder symptoms, fever, and watery diarrhea without mucus 1.
Age-Specific Considerations
While intussusception classically affects infants between 5-9 months of age 2, it remains an important diagnosis in the 4-12 year age range 1. In this older pediatric population, the severity of pain and presence of mucus in stool are crucial differentiating factors from more common conditions like gastroenteritis or constipation 1.
Important Clinical Caveat
The classic triad of abdominal pain, bloody stools, and palpable abdominal mass is actually seen in only a minority of patients 3. More commonly, children present with nonspecific findings including lethargy, irritability, vomiting, and the mucoid stools described in this case 3, 2. This makes early diagnosis dependent on maintaining a high index of suspicion 3.
Immediate Diagnostic Approach
- Ultrasound should be performed early as it is safe, sensitive, and specific for diagnosing intussusception 3
- Plain abdominal radiography lacks sufficient sensitivity to reliably exclude intussusception, though it may be part of the initial workup 3
- Contrast enema (pneumatic or hydrostatic) serves as both the gold standard for diagnosis and first-line treatment 3
Critical Pre-Treatment Steps
Before attempting contrast enema reduction 3:
- Establish intravenous access
- Initiate fluid resuscitation
- Notify the pediatric surgeon
This is a surgical emergency requiring immediate evaluation and intervention to prevent bowel ischemia, perforation, and peritonitis 4, 2.