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Two children with lethargy and intussusception
R W Hickey1, S K Sodhi, W R Johnson
1Department of Pediatrics, Medical Center of Delaware, Wilmington.
Insights
Lethargy can be a primary symptom of intussusception in children. Prompt recognition of lethargy with gastrointestinal signs is crucial for diagnosing this condition.
Area of Science:
- Pediatric Medicine
- Gastroenterology
- Emergency Medicine
Background:
- Intussusception is a common surgical emergency in infants and young children.
- Classic symptoms include abdominal pain, vomiting, and bloody stools.
- Lethargy is not typically considered a primary presenting symptom.
Observation:
- Two pediatric cases are presented where lethargy was the predominant initial symptom.
- Both patients eventually presented with right lower quadrant abdominal tenderness and heme-positive stool.
- Diagnosis was delayed until the development of these more specific gastrointestinal signs.
Findings:
- Lethargy, when accompanied by gastrointestinal symptoms like abdominal tenderness and bloody stools, can indicate intussusception.
- This presentation highlights a less common but significant clinical manifestation of intussusception.
- Early recognition of subtle signs is vital for timely intervention.
Implications:
- Physicians should consider intussusception in pediatric patients presenting with unexplained lethargy, especially if accompanied by GI symptoms.
- Increased awareness of lethargy as a potential primary symptom may lead to earlier diagnosis and treatment.
- This can improve outcomes and reduce complications associated with delayed intussusception diagnosis.
Abstract:
The cases of two patients with lethargy as the predominant symptom of intussusception are described. The first patient was admitted to the pediatric ICU with unexplained lethargy. The diagnosis of intussusception was made after he developed right lower quadrant abdominal tenderness and heme-positive stool. The second patient was diagnosed after presenting to the emergency department with intermittent lethargy, right lower quadrant abdominal tenderness, and heme-positive stool. The presence of gastrointestinal symptoms or signs in association with lethargy should alert the physician to the possibility of an intussusception.