From the Guidelines
The best next step in management of this patient is option D: Perform air contrast enema. This approach is recommended for diagnosing and treating intussusception, which is a potential cause of small-bowel obstruction (SBO) in patients, especially in the pediatric age group or in those with a history of bariatric surgery 1. When a patient presents with symptoms such as abdominal pain, vomiting, or bloody stools, an air contrast enema can be both diagnostic and therapeutic, as it can help reduce the intussusception and relieve the obstruction. The use of imaging studies like CT or MRI is also valuable in diagnosing SBO and its causes, including intussusception, but an air contrast enema is more specific for intussusception and can be therapeutic 1. Eliminating dairy from the maternal diet (option A) would be more appropriate if the patient is an infant suspected of having a cow's milk protein allergy. Obtaining stool cultures (option B) would be more relevant if an infectious cause of the symptoms is suspected. Ordering an abdominal x-ray (option C) may help identify some causes of obstruction but is less specific than other imaging modalities for diagnosing intussusception or other complex causes of SBO. Performing a Meckel scan (option E) is specific for diagnosing a Meckel's diverticulum, which is another potential cause of gastrointestinal bleeding or obstruction, but it is not the best initial choice for suspected intussusception or SBO of other causes. Given the potential for intussusception or other serious conditions causing SBO, as discussed in the context of bariatric surgery complications 1, a more direct and specific diagnostic approach like an air contrast enema is preferred for its therapeutic potential and diagnostic clarity in cases where intussusception is suspected.
From the Research
Diagnostic Approach
- The patient's symptoms suggest a possible intestinal obstruction or intussusception, which may be caused by a Meckel's diverticulum 2, 3, 4.
- Imaging tests such as abdominal ultrasonography, tomography, and enterotomography can help diagnose intussusception and Meckel's diverticulum 5, 3, 4.
Management Options
- Perform air contrast enema (option D) is a common diagnostic and therapeutic approach for intussusception in children, but its effectiveness in adults is limited 5.
- Perform Meckel scan (option E) can help diagnose Meckel's diverticulum, but it may not be necessary if other imaging tests are already suggestive of the diagnosis 2, 3, 4.
- Obtain stool cultures (option B) may not be directly relevant to the diagnosis of intussusception or Meckel's diverticulum 2, 5, 3, 4.
- Eliminate dairy from maternal diet (option A) is not relevant to the diagnosis or management of intussusception or Meckel's diverticulum in this context 2, 5, 3, 4.
- Order abdominal x-ray (option C) may not provide sufficient information to diagnose intussusception or Meckel's diverticulum 2, 5, 3, 4.