Pediatric emergency medicine trisk 4508 4508
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Infants with an air- and liquid-filled stomach often have a gastric outlet that is
pushed beyond midline to the right side of the abdomen, and often the pylorus
dives posteriorly. In this setting, rotating the infant to the right decubitus position
can improve visualization. Allowing the child to feed clear fluids during the
examination facilitates identification of the pylorus by providing an excellent
acoustic window. If available, warm gel will improve probe contact as infants are
particularly intolerant of cold gel.
FIGURE 131.20 Longitudinal view of pylorus. The “A” calipers measure the muscle thickness
and the “B” calipers measure the channel length.
Intussusception
Anatomy
Intussusception occurs when a loop of bowel, the intussusceptum, advances
distally and, through peristalsis, becomes trapped in the distal bowel lumen, the
intussuscipiens. The bowel wall becomes edematous and intestinal obstruction
ensues. The most common site of intussusception is the ileocolic region of the
bowel. Mesentery, vascular supply, and lymph tissue accompany the invaginated
loop and, as entrapment persists, ischemia develops and the bowel is at risk of
perforation. Small bowel intussusceptions can occur but are typically selfresolving.
