Pediatrics Answers 421372.The answer is b.(Fleischer and Ludwig, pp 1611-1613.)This is a clas-
sic story and presentation for intussusception, where a part of intestine
telescopes inside of another and causes ischemia, which can lead to
infarction of bowel. This is a true GI emergency.The most common type
of intussusception is ileo-colic and the most common reason is idiopathic.
Ileo-ileal and colo-colonic intussusceptions are possible though rare in
comparison.The most common age group is 3 to 12 monthswith
greater than 80% occurring within the first 2 years of life. Air enema is both
diagnostic and therapeutic and has been adopted as the intervention of
choice for these patients.
(a)Although the classic triad consists of colicky abdominal pain, vom-
iting, and currant jelly stools, fewer than 20% of patients will present with
all of these findings. (c)Plain films cannot typically confirm or refute the
presence of intussusception, though air present in the cecum indicates no
ileo-colic intussusception. Ultrasound has been employed and demon-
strated to have very high sensitivity for intussusception. (d)Although sur-
gical consultation is warranted prior to reduction in the case that
perforation is identified with the enema or for unsuccessful reductions, rel-
atively few patients ultimately require surgical correction. (e)There is a
lead point in a small minority of patients in the classic age range. The inci-
dence of pathologic lead points increases as the age of the patient increases
beyond the classic age group. Lead points can be hypertrophied Peyer
patches, diverticula, a polyp, or a tumor.
373.The answer is a.(Fleischer and Ludwig, pp 929-930.)Acute chest syn-
drome is characterized by pneumonia with pulmonary infarction,
hypoxia, and diffuse pulmonary edema.This is one of the most serious
and life-threatening complications of sickle-cell disease. One must be very
cautious with IV fluid hydration because over aggressive fluid administration
can lead to pulmonary edema in patients who have pneumonia or who have
previously suffered from acute chest syndrome. Administration of IV antibi-
otics, transfusions for anemia, and oxygen are the mainstays of therapy.
(b)Disseminated infection leading to sepsis and (c)empyema are
complications of bacterial pneumonia in general. Patients with sickle-cell
disease have an inherent immunodeficiency owing to autosplenectomy, but
these are not specific complications of this patient’s treatment. (d)Stroke is
another complication of sickle-cell disease but it is not caused by fluid
resuscitation. (e)Likewise, patients with long standing anemia are at risk
for congestive heart failure and indeed, many patients with sickle-cell dis-
ease have an enlarged heart. However, this is a chronic complication and