Abdominal ultrasound

You request an urgent abdominal ultrasound and after around 30 minutes Charlie is taken to the radiology department.

You go with her to the ultrasound department to watch the ultrasound, and when you are there the surgical team also arrives. They have heard the child is in the hospital and is having the ultrasound.

The radiologist scans. Charlie is in some discomfort again.
The kidneys, gall bladder and the liver are all normal, and there is a bit of fluid in the pelvis. This appearance is seen in the right upper quadrant:

The surgeon looks impressed and the specialists discuss how they are going to reduce the intussusception – by open procedure or using an air enema. They decide the air enema is the best initial approach.

Charlie undergoes the air enema. A small tube is passed into her rectum and air pushed in. It is uncomfortable for Charlie and she becomes upset. Her parents did not want to come in to the room with her as they did not want to see her upset, but the paediatric nurse comforts her.

The air is not able to reduce completely the intussusception and after 15 minutes the procedure is stopped. The tube is taken out and Charlie’s parents come back in. They have brought some of her toys and some food.

The surgical team explains that she has an intussusception, but that she will need an operation to correct this. They will take her to theatre as soon as one is free.

In the meantime you results have come back, sent by a colleague earlier.

Hb                                           89        g/L
Wcc                                        15.1 x 10⁹/L
Plats                                        474 x 10⁹/L
Urea                                        8.2 mmol/L
Na                                           145 mmol/L
K                                             3.7 mmol/L
Creat                                       41 micromol/L
CRP                                        38 mg/L
Ca                                            2.35 mmol/L
PO₄                                         0.57 mmol/L
Ferritin                                   72 microg/L
Vitamin B₁₂                             550 nanog/L
Folate                                     81 microg/L
Vitamin D                               <10 iU/L
Alkaline phosphatase854 iU/L

After 2 hours she is taken to theatre. At laparotomy an ilio-colic intussusception is seen and reduced. A 5 cm ischaemic segment is seen and this is resected with an end to end anastomosis.

The procedure is uncomplicated and she returns to the ward. The instructions for the ward staff are to keep her nil by mouth for 24 hours and to give her 48 hours of antibiotics.

Her mother is waiting for her – her husband is looking after their other children at the moment. She is relieved that the operation went so well.