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[Changes in the consciousness state as a symptom of intestinal invagination onset]
R Sangermani1, M Gibelli, P Vaglia
1Divisione di Pediatria, Ospedale S. Carlo Borromeo, Milano, Italia.
Insights
Intussusception in children can present with unusual neurological symptoms like altered consciousness and lethargy. Suspect intussusception in children with vomiting and lethargy, even without typical signs.
Area of Science:
- Pediatric Gastroenterology
- Pediatric Neurology
Background:
- Intussusception is a common cause of intestinal obstruction in children aged 3-5 years.
- Diagnosis is typically straightforward with classic symptoms.
Observation:
- Rare cases of intussusception present with atypical symptoms including central nervous system (SNC) involvement.
- Four cases are presented with initial symptoms of altered consciousness, hypotonia, and vomiting.
- These symptoms necessitate differential diagnosis with other causes of comatose states.
Findings:
- Atypical intussusception presentation can mimic other neurological conditions, potentially delaying diagnosis and treatment.
- Hypothesized mechanisms include endorphin release, bacterial neurotoxins, or abnormal intestinal hormone production.
- The association of vomiting and lethargy in children warrants suspicion for intussusception.
Implications:
- Early recognition of atypical intussusception is crucial for timely intervention.
- Abdominal imaging (radiography or tomography) is recommended for children with vomiting and lethargy, even without pathognomonic signs.
- This case series highlights the importance of considering intussusception in the differential diagnosis of pediatric neurological emergencies.
Abstract:
Intussusception is the most frequent cause of intestinal occlusion in children aged 3-5 years. Diagnosis is easy to perform in cases with typical clinical presentation. However diagnosis may be difficult in rare cases with atypical symptoms characterized by SNC involvement, that could delay a convenient treatment. We report 4 cases of intussusception presenting initially with consciousness abnormalities, hypotonia and vomiting. In these cases differential diagnosis with other conditions associated with comatose states has to be performed. Some hypothesis may be considered to explain these clinical pictures: 1. increased endorphins excretion during abdominal pain; 2. neurotoxins of bacterial origin released and absorbed by altered bowel; 3. intestinal hormones abnormally produced during the disease. As recommended by Rachmel, the condition should be suspected in all children presenting with the association of vomiting and lethargy and a radiological or tomographic study of abdomen should be performed also in cases without intussusception typical symptoms.