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Stool appearance in intussusception: assessing the value of the term "currant jelly"
L G Yamamoto1, S Y Morita, R B Boychuk
1Emergency Services, Kapiolani Medical Center for Women and Children, Honolulu, HI 96826, USA.
Insights
The classic "currant jelly stool" is rare in pediatric intussusception. Most bloody stools in intussusception cases are described with terms like "bloody" or "mucus," necessitating broader diagnostic considerations.
Area of Science:
- Pediatric Gastroenterology
- Medical Education
Background:
- Intussusception is a common cause of intestinal obstruction in infants and children.
- The classic diagnostic sign of intussusception is the "currant jelly stool."
Purpose of the Study:
- To evaluate the actual appearance of stools in pediatric intussusception cases.
- To assess the clinical utility of the term "currant jelly stool" in medical education.
Main Methods:
- Retrospective chart review of 107 inpatient children diagnosed with intussusception.
- Analysis of stool appearance descriptions, including spontaneous passage and rectal examination findings.
Main Results:
- Only a minority of grossly bloody stools in intussusception resembled pure currant jelly.
- Common descriptions for bloody stools included "bloody," "mucus," "red," and "diarrhea."
- Bloody stools were observed in 56 patients spontaneously and 8 via rectal examination.
Conclusions:
- The term "currant jelly stool" may not accurately represent the most common stool presentation in pediatric intussusception.
- Broader descriptive terms for bloody stools are more objective and sensitive for identifying intussusception.
- Medical education should emphasize considering intussusception in children with any type of bloody stool to improve diagnostic timeliness.
Abstract:
This study surveyed the stool appearance descriptions of 107 inpatient children with intussusception. Fifty-six patients presented with grossly bloody stools (passed spontaneously), 10 of which were determined on chart review to resemble currant jelly. Of the 51 patients without grossly bloody spontaneously passed stools, 35 patients had rectal examination results charted. Eight of these children had grossly bloody stools noted on rectal examination, 4 of which were determined on chart review to resemble currant jelly. While most of the grossly bloody stools were not consistent with pure currant jelly, the most common terms used in describing the grossly bloody stools were "bloody," "mucus," "red," and "diarrhea." Since stools truly resembling currant jelly account for a minority of the grossly bloody stools in intussusception, the term "currant jelly stools" should be assessed in the teaching of intussusception. Generic terms such as blood, mucus, burgundy, red, etc, are more objective and sensitive at identifying cases of intussusception. Junior physicians who are taught the classic presentation of intussusception with currant jelly stool should also be taught that intussusception should be considered in the differential diagnosis of children passing any type of bloody stool. As a result, physicians with limited experience will be more likely to appropriately consider the diagnosis of intussusception, permitting a more timely diagnosis and a better outcome.