Abdominal Ultrasound

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

Shortly after she has gone, the paediatric surgical team arrives having completed the pyloromyotomy operation on a 7 week old girl. They suggest that you accompany them to the radiology department to watch the ultrasound, and as they have not seen the child, to be introduced to the family.

When you arrive, the radiologist is already scanning the abdomen. She is a little excited. Charlie is in some discomfort again, even though the radiologist has stopped scanning for the moment.

The kidneys, gall bladder and the liver are all normal, and there is a bit of fluid in the pelvis, but I also saw this:

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.

Soon the procedure is finished and the ultrasound shows the intussusception has gone. The tube is taken out and Charlie’s parents come back in. They have brought some of her toys and some food.

The surgeon reviews her abdomen which still looks distended. She passes a large amount of wind and then it looks less distended. It is still tender. The paediatric surgeon decides to send her to the children’s ward for observation. She is not to eat for at least 6 hours in case the intussusception recurs and she then needs to go to the operating theatre.

The following morning she is looking very well. She has had a comfortable night, unlike her mother, who says she has barely slept.

Some more results have come back, sent by a colleague overnight.

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

Charlie has been eating and drinking well and has opened her bowels – a bulky, messy mucousy stool.

Charlie’s mother asks if she can take her home.

What is your next plan?