Initially, loose or watery stools are present concurrent with vomiting and, within 12-24 hours, blood or mucous is passed rectally. Early in the course, the patient appears completely well in between episodes of abdominal pain. Lethargy may dominate the initial presentation. However, lethargy usually occurs later in the process. A vertically oriented mass may be palpable in the right upper quadrant.
Fever is a late finding and is suggestive of enteric sepsis.
In neonates and those older than 3 years, a mechanical lead point usually can be found. Plain abdominal films may be normal early in the disease or may show perforation, typical obstructive pattern, or soft tissue mass of the intussusception on the right side. A paucity of gas in the right upper quadrant may be present. Ultrasound has been used to diagnose an intussusception. The contrast enema should only be performed in consultation with the surgeon caring for the child and the radiologist interpreting the study.