Differential Diagnosis for Acute Intermittent Abdominal Pain in a 6-year-old Boy
- Single most likely diagnosis
- Intussusception: This condition is characterized by the telescoping of one segment of intestine into another, leading to intermittent abdominal pain, vomiting, and sometimes bloody stools. The presence of concentric rings of bowel on ultrasound, known as the "target sign" or "doughnut sign," is highly suggestive of intussusception. The patient's symptoms, including acute intermittent umbilical abdominal pain radiating to the right lower abdomen, nonbilious vomiting, and the specific ultrasound findings, strongly support this diagnosis. Intussusception is a common cause of intestinal obstruction in children and can lead to ischemia and necrosis if not promptly treated.
- Other Likely diagnoses
- Meckel diverticulum: This is a congenital anomaly of the small intestine that can cause abdominal pain, vomiting, and gastrointestinal bleeding due to the presence of ectopic gastric or pancreatic tissue. While it could potentially lead to intussusception, the ultrasound findings in this case more directly suggest intussusception itself rather than the diverticulum being the primary issue.
- Malrotation with volvulus: This condition involves an abnormal rotation of the intestine during fetal development, which can lead to volvulus (twisting of the intestine) and subsequent obstruction or ischemia. However, the ultrasound findings and the nature of the pain described do not as strongly suggest this diagnosis as they do intussusception.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Appendicitis: Although the presentation might not be typical for appendicitis (which usually presents with more constant pain and might not have the same pattern of vomiting), it's crucial to consider appendicitis due to its potential for severe complications if not promptly treated. The location of pain and the absence of other classic signs, however, make this less likely.
- Volvulus: Similar to malrotation with volvulus, any condition leading to twisting of the intestine can cause severe, acute abdominal pain and vomiting. The key to diagnosing volvulus is recognizing the high risk of intestinal ischemia and necrosis, which necessitates urgent intervention.
- Rare diagnoses
- Intestinal polyps: While polyps can cause intussusception by serving as a lead point, they are less common in children and would not directly explain the ultrasound findings without the context of intussusception.
- Intestinal adhesions: These are more commonly seen in patients with a history of abdominal surgery and can cause bowel obstruction. The clinical presentation and ultrasound findings do not strongly support this diagnosis in the context provided.