Intussusception trivia

Some mnemonics are useful and others are just plain trivia. Here is some intussusception trivia that is easy to remember:

  • In adults, a cause may be found in 2/3 of cases
  • 2/3 of known causes will be due to neoplasm
  • 2/3 of these neoplasms are malignant

This is why some may prefer to resect an intussusception in an adult (as opposed to reduce it as is done in children).

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Source: This bit of trivia was found in Skandalakis’ Surgical Anatomy.

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Scoring and risk stratification (part 5)

The Alvarado score is a popular score used in emergency medicine to determine the likelihood of an appendicitis. This score is a high sensitivity for appenciditis and is therefore best for ruling it out (sensitivity of a score of 5 is 99% and specificity of a score of 7 is 81%). It is unreliable in children and more reliable in men than women. You may refer to a systematic of the Alvarado score below.

The Alvarado score has 8 criteria for a total score of 10 points. Alvarado score may be remembered using the following memory trick: “My Appendix Feels Likely To Rupture Now”.

My = Migration of pain to the right iliac fossa

Appendix = Anorexia

Feels = Fever of 37.3 Celsius or more

L = Leukocytosis

T = Tenderness in the right iliac fossa

R = Rebound tenderness

N = 1) Nausea or vomiting 2) Neutrophilia

**Tenderness in the right lower quadrant and leukocytosis count for 2 points each. All other criteria count for 1 point.

A score of 1 to 4 points has a 30% probability of being appendicitis. No imaging is suggested (note: if score is 4 points and there is clinical suspicion, imaging is suggested). The patient may be discharged.

A score of 5 to 6 points has a 66% probability of being appendicitis. A CT of the abdomen is suggested. The patient should be observed +/- admitted.

A score of 7 to 10 points has a 93% probability of being appendicitis. Consult a surgeon.


Please refer to this article by Ohle et al. entitled “The Alvarado score for predicting acute appendicitis: a systematic review” for more reading. Thanks for reading!

*Note: this tool (and other risk stratification tools posted on this blog) is only for use by medical professionals in the medical context. If you are concerned for your health, please consult your physician!

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Triads, pentads and classic presentations (part 10)

So the “Triads, pentands and classic presentations” series has reached its 10th post! Just when you thought all the good ones were already posted here, here is another one!

Borchadt’s triad for gastric volvulus:

1) severe epigastric pain

2) retching without vomiting

3) inability to pass a nasogastric tube

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Have a great week! Good luck to those writing their pre-holiday university exams.

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Click here to share a mnemonic for a future edition of The Weekly Mnemonic.