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Painless intussusception and altered mental status
R Birkhahn1, M Fiorini, T J Gaeta
1Department of Emergency Medicine, New York Methodist Hospital, Brooklyn 11215, USA.
Insights
A rare case of intussusception in a 7-month-old infant presented with unusual symptoms like hematemesis and lethargy. Abdominal ultrasound was crucial for diagnosing this common childhood condition.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Imaging in Children
Background:
- Intussusception is a common surgical emergency in infants and young children.
- Typical symptoms include colicky abdominal pain, vomiting, and a palpable abdominal mass.
- Atypical presentations can delay diagnosis and treatment.
Observation:
- A 7-month-old infant presented with painless emesis, progressing to hematemesis, hematochezia, and unresponsiveness.
- Initial differential diagnoses included toxic ingestion, intracranial bleed, sepsis/meningitis, and intraabdominal pathology.
- The patient remained hemodynamically stable throughout the initial evaluation.
Findings:
- Abdominal ultrasound revealed ileal-cecal intussusception.
- Surgical reduction was required for definitive treatment.
- This case highlights an insidious presentation of intussusception.
Implications:
- Abdominal ultrasound is a valuable, non-invasive tool for diagnosing intussusception in hemodynamically stable children.
- Recognizing atypical symptoms is crucial for timely diagnosis and management of intussusception.
- This case underscores the importance of considering intussusception even with unusual clinical signs.
Abstract:
A 7-month-old child presented to the emergency department (ED) with 2 hours of painless, nonprojectile emesis and a normal mental status. Over a 3-hour period in the ED, the child remained pain-free, but developed hematemesis, hematochezia, and lethargy, progressing to unresponsiveness. The patient was evaluated for toxic ingestion, intracranial bleed, sepsis/meningitis, and intraabdominal pathology. The diagnosis was made by an abdominal ultrasound, which demonstrated an ileal-cecal intussusception that ultimately required surgical reduction. This case illustrates an insidious and poorly understood presentation of a common childhood affliction, as well as the utility of abdominal ultrasound in evaluating a hemodynamically stable patient with intussusception.