Differential Diagnosis for a 10-month-old Boy with Bloody, Mucoid Stools and Vomiting
Single most likely diagnosis
- B) Intussusception: This condition is characterized by the telescoping of one portion of the intestine into another, leading to bowel obstruction and potentially ischemia. The classic triad of intussusception includes abdominal pain, vomiting, and bloody, mucoid stools (often described as "currant jelly" stools due to the presence of blood and mucus). The presence of a palpable abdominal mass and the findings on the contrast enema support this diagnosis, as intussusception can cause an obstructive pattern and a mass may be felt if the intussusception is large enough.
Other Likely diagnoses
- A) Bleeding diverticulum: Although less common in infants, a bleeding diverticulum could cause bloody stools. However, it would not typically cause the vomiting or the palpable mass described.
- C) Malrotation volvulus: This condition involves a twisting of the intestine that can cause obstruction and ischemia. While it can present with vomiting and abdominal pain, the presence of bloody, mucoid stools is less typical unless there is significant ischemia.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- C) Malrotation volvulus: Despite being less likely based on the specific symptoms described, malrotation volvulus is a surgical emergency that can lead to rapid deterioration and death if not promptly diagnosed and treated.
- D) Peptic ulcer: Although rare in infants and not typically presenting with bloody, mucoid stools, a perforated peptic ulcer can be catastrophic and requires immediate surgical intervention.
Rare diagnoses
- E) Pyloric stenosis: Typically presents with projectile vomiting after feeding and is less likely to cause bloody stools. It's more common in younger infants and doesn't usually present with the combination of symptoms described.
- Other rare conditions such as Meckel's diverticulum with bleeding, intestinal duplication, or vascular malformations could also be considered but are less likely given the clinical presentation and findings.