Intussusception

A parent's worst nightmare!

Last week, baby Luis' daycare (will post more on that later) called me at work to let me know baby was vomiting. Daddy picked him up right away and told me that he did not look well. Poor baby was pale and lethargic; he had hardly eaten anything all day.  I asked Luis to meet me at the urgent care. When I arrived, baby was weak and still vomiting, even with just drinking a bit of pedialyte.  He was given Zofran, a nausea medication; the urgent care physician felt that he was overall stable given that his vitals looked great and he did not have signs and symptoms of severe dehydration.  He felt that baby could go home and would do better once the Zofran kicked in, as his condition had not progressed.  Luis and I were fine with this plan, and decided that we would promptly take him to the ER to receive IV fluids if the vomiting did not improve at home. However right as we were packing up to leave, baby seemed to be in pain as he was going #2. We changed his diaper, and saw lots of blood and mucous in the diaper, which I recognized as "currant jelly stools."  This is the hallmark or classic sign for a condition called Intussusception.

Intussusception is when one segment of the intestines slides into another part, causing an intestinal obstruction. The "currant jelly stools" is characteristic, along with nausea, vomiting, and severe episodic abdominal pain.

 I knew right then that we needed to go to the ER immediately. The urgent care physician agreed.  We took him to the Loma Linda University ER. Grandma, Grandpa, and Nino Rafi met us there as well. Boy, was baby happy to see his loved ones! I clearly indicated to the triage staff that I felt he had an intussusception and yet he was not brought back to be evaluated in an expeditious manner, which was quite frustrating.  This is a medical emergency and there are many, many serious possible sequelae that could occur if not treated promptly.  He continued with bloody diaper after bloody diaper while we waited.  Fortunately, he appeared for the most part comfortable in our arms.  Had something changed, or if he was in an extreme amount of discomfort, I would have insisted that he needed to be seen immediately and would have spoken directly to a PA or physician. I believe that the triage individuals were not sufficiently trained to recognize which situations needed more immediate attention. 

Baby was assessed and still, it took awhile but finally after the abdominal xray, the attending physician and team decided that yes, he appeared to have an intussusception and recommended a barium enema. Again, frustrating..however we were just happy to have him finally in the ER and being attended to. The barium enema is diagnostic and also works as the treatment; if the intusussception is not reduced with the barium enema, surgical intervention is the next step.  The procedure was painful for Daddy and I, as baby was screaming in pain.  It truly was horrible, and seemed like it would never be over, but finally it was, and was successful. I was just so glad that he would not need surgery and that there were no complications- all of which I was preparing myself for when I first saw the current jelly stools.  He perked up shortly after, thank goodness. Baby was monitored overnight then we went home the next day.  He is susceptible to a recurrence, however the high risk time frame is 72 hours after.  Thus far, it has been 9 days and no recurrence; baby is back to his active, happy self!