Differential Diagnosis
- 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 symptoms includes abdominal pain (often intermittent, with episodes of drawing up the legs), vomiting (which can be non-bilious initially), and bloody stools (classically described as "currant jelly" stools due to the presence of blood and mucus). The age of the patient and the combination of symptoms (vomiting, bloody stools, episodes of fussiness and drawing up the legs) make intussusception a highly likely diagnosis.
- Other Likely diagnoses
- A) Gastroenteritis: Although gastroenteritis can cause vomiting and bloody stools, the presence of bloody stools with mucus and the specific behavior of drawing up the legs suggest a more mechanical issue like intussusception. However, gastroenteritis remains a possible diagnosis, especially given the fever and vomiting.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- C) Meckel diverticulum: A Meckel diverticulum can cause gastrointestinal bleeding due to the presence of ectopic gastric mucosa, but it typically presents with painless, large-volume bleeding. However, it's a condition that could lead to significant blood loss and should be considered in the differential, especially if intussusception is ruled out.
- D) Necrotizing enterocolitis: Although more common in premature infants, necrotizing enterocolitis can occur in term infants and is a life-threatening condition. Symptoms include abdominal distension, vomiting, and bloody stools. Given the severity of this condition, it should be considered, even though the patient was born at term and the presentation might not fully align.
- Rare diagnoses
- E) Pyloric stenosis: Typically presents with non-bilious vomiting that progresses to projectile vomiting, usually without blood in the stool. The age of presentation is often between 3 to 6 weeks, making this a less likely diagnosis for a 13-month-old infant. However, it's a condition that affects the gastrointestinal tract and could be considered in a broad differential diagnosis, especially if other symptoms were present.