BMJ Open Gastro. 2015;2(1)
Abstract and Introduction
Abstract
Objective To highlight a new phenomenon that we have encountered in children during the past 5 years. Children in this group have a pathognomonic clinical picture of sudden acute severe abdominal colic during which the child is continuously screaming for 1–2 min. All these patients were initially diagnosed on clinical and ultrasonographic grounds as acute intussusception. Careful interpretation of the radiological findings revealed faecal impaction of the terminal ileum and caecum.
Design This is a retrospective study looking at children presenting between 2009 and 2014 with acute severe abdominal colic pain. These were 11 patients aged 9 months to 5 years. We reviewed our experience in the management and diagnosis of these patients.
Result All patients were diagnosed initially as intussusception, which was confirmed by ultrasonography (US). US revealed an appearance mimicking intussusception, 3 cases of which were intermittent. This US appearance proved to be a hard stool filling the terminal ileum. In all patients, abdominal X-ray revealed stool at the right side of the colon filling the caecum. Diagnostic gastrografin enemas that were performed in four patients excluded intussusception and confirmed stool at the caecum and ascending colon. In none of those patients had contrast passed into the terminal ileum. There was dramatic response to fleet and/or gastrografin enemas. Five patients required a second dose of enema and two patients required three doses.
Conclusions We highlight a new phenomenon of severe abdominal pain caused by faecal impaction of the terminal ileum and caecum. Increased awareness of this condition helps to avoid unnecessary investigations and/or surgical exploration.
Introduction
Abdominal pain and/or colic are common symptoms in the paediatric age group, the causes of which depend on age and associated symptoms. In the past, intussusception remained the primary cause of abdominal colic in children below 2 years of age. Constipation is known to be associated with abdominal pain, but has not been known to be severe enough to warrant urgent attention. All the patients in this report presented with sudden recurrent severe colicky abdominal pain, during which they screamed in agony for 1–2 min, with the pain ending abruptly. We have learned from earlier experience with similar cases to be cautious in labelling these types of cases as intussusception and to treat them conservatively with enemas.
