A 25-year-old male presents to the emergency department with acute abdominal pain, blood and mucus in his stool, and a palpable mass in the abdomen. The patient has no significant past medical history but reports that the pain started suddenly and has been worsening.
Question:
The most likely diagnosis in this young male presenting with acute abdominal pain, blood and mucus in his stool, and a palpable mass per abdomen is:
A. Meckel’s diverticulum
B. Volvulus
C. Intussusception
D. Hypertrophic pyloric stenosis
The Correct Answer is: C. Intussusception
Explanation:
Intussusception:
Intussusception is a condition where a part of the intestine folds into the section immediately ahead of it. This can lead to a blockage, causing acute abdominal pain, blood, and mucus in the stool (often described as “currant jelly” stools), and a palpable mass in the abdomen. Although intussusception is more common in infants and young children, it can also occur in young adults, especially in the presence of a pathological lead point such as a polyp or Meckel’s diverticulum. The combination of symptoms described in the scenario makes intussusception the most likely diagnosis.
Explanation of Incorrect Options:
Meckel’s diverticulum can present with painless rectal bleeding or diverticulitis, which may cause abdominal pain. However, the presence of a palpable mass and the acute presentation with blood and mucus in the stool are less characteristic of Meckel’s diverticulum compared to intussusception.
B. Volvulus:
Volvulus involves the twisting of the intestine, which can cause acute abdominal pain and obstruction. While it can present with similar symptoms, it is less likely to cause blood and mucus in the stool and a palpable mass compared to intussusception.
D. Hypertrophic pyloric stenosis:
Hypertrophic pyloric stenosis typically presents in infants with projectile vomiting and a palpable “olive” mass in the upper abdomen. It does not cause blood and mucus in the stool and is not a typical diagnosis in young adults.
Given these considerations, intussusception (Option C) is the most likely diagnosis in a young male presenting with acute abdominal pain, blood and mucus in the stool, and a palpable mass per abdomen.