A 10 month old has had apparent abdominal pain for the past 4 hours. During episodes of pain, the infant screams inconsolably and draws his legs towards the abdomen, has vomiting but no diarrhea. Between episodes the infant is calm. The MOST LIKELY diagnosis is

A 10 month old has had apparent abdominal pain for the past 4 hours. During episodes of pain, the infant screams inconsolably and draws his legs towards the abdomen, has vomiting but no diarrhea. Between episodes the infant is calm. The MOST LIKELY diagnosis is

• A. Meckel's diverticulitis
• B. Intussusception
• C. Acute appendicitis
• D. Acute gastroenteritis

Answer: (B)

Intussusception presents with intermittent, severe abdominal pain that causes the infant to scream and draw the legs toward the abdomen, often with vomiting, and the child may appear calm between episodes. This waxing and waning pattern happens because a segment of bowel telescopes into another, causing brief obstruction and cramping that recurs as the trapped loop irritates the gut. In a 10-month-old, this episodic, colicky pain with vomiting and no persistent diarrhea is the classic presentation, making intussusception the most likely diagnosis. Meckel’s diverticulitis would more typically cause painless bleeding or a different course of symptoms. Acute appendicitis in this age is unlikely, as it usually presents with more continuous pain, fever, and peritoneal signs rather than discrete, self-limited episodes. Acute gastroenteritis would typically include diarrhea, and sometimes fever, rather than this pattern of episodic pain with brief calm periods.

Intussusception presents with intermittent, severe abdominal pain that causes the infant to scream and draw the legs toward the abdomen, often with vomiting, and the child may appear calm between episodes. This waxing and waning pattern happens because a segment of bowel telescopes into another, causing brief obstruction and cramping that recurs as the trapped loop irritates the gut. In a 10-month-old, this episodic, colicky pain with vomiting and no persistent diarrhea is the classic presentation, making intussusception the most likely diagnosis.

Meckel’s diverticulitis would more typically cause painless bleeding or a different course of symptoms. Acute appendicitis in this age is unlikely, as it usually presents with more continuous pain, fever, and peritoneal signs rather than discrete, self-limited episodes. Acute gastroenteritis would typically include diarrhea, and sometimes fever, rather than this pattern of episodic pain with brief calm periods.