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Intussusception. A case that suggests a new cardinal symptom--lethargy
1Department of Family and Community Medicine, Bowman Gray School of Medicine, Winston-Salem, NC 27103.
Insights
Intussusception, a common cause of bowel obstruction in children, can be life-threatening if missed. Lethargy may be a key early symptom, aiding timely diagnosis and improving outcomes.
Area of Science:
- Pediatric Medicine
- Gastroenterology
Background:
- Intussusception is the most common cause of bowel obstruction in children aged 3 months to 5 years.
- Delayed diagnosis can lead to severe complications like bowel necrosis, perforation, and death.
Observation:
- Traditional cardinal symptoms (abdominal pain, rectal bleeding, vomiting, abdominal mass) are not always present.
- Lethargy can be a significant presenting feature, especially in infants without reported abdominal pain.
Findings:
- Lethargy may serve as a fifth cardinal symptom of intussusception.
- Recognizing lethargy alongside other symptoms can indicate serious illness.
Implications:
- Increased awareness of lethargy as a symptom can lead to earlier intussusception diagnosis.
- Earlier diagnosis is associated with improved patient outcomes and reduced morbidity.
Abstract:
Intussusception is an uncommon condition, but it is the most frequent cause of bowel obstruction in infants and children aged 3 months to 5 years. If undiagnosed, it can result in bowel necrosis, perforation, and even death. Four cardinal signs and symptoms (abdominal pain, rectal bleeding, vomiting, and abdominal mass) are described in patients with intussusception, but these manifestations are not always present and their absence may lead to misdiagnosis. Lethargy might be considered a fifth cardinal symptom. As demonstrated in this case, lethargy may be a significant presenting feature in an infant with no history of abdominal pain, and in association with the other cardinal symptoms, it may be an early indication of a significant illness such as intussusception. Awareness of this association may result in an earlier diagnosis and an improved outcome in patients with intussusception.