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Intussusception: a supplement to the mnemonic for coma
Insights
Intussusception can present subtly in infants with lethargy and vomiting, delaying diagnosis. Prompt imaging like ultrasound or barium enema is crucial for infants with unexplained lethargy.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Imaging
Background:
- Intussusception is a common surgical emergency in infants.
- Typical symptoms include abdominal pain, vomiting, mass, and rectal bleeding.
Observation:
- A case of infant intussusception presented with lethargy and vomiting.
- Initial examination lacked classic signs like pain, melena, or abdominal mass.
- This led to diagnostic delay due to altered sensorium without overt pain.
Findings:
- Lethargy and vomiting can be atypical presenting symptoms of intussusception.
- Diagnostic challenges arise when classic signs are absent.
Implications:
- Emphasizes the need for heightened clinical suspicion in infants with non-specific symptoms.
- Recommends prompt abdominal imaging (radiographs, ultrasound, or barium enema) for unexplained infant lethargy.
- Highlights the importance of timely diagnosis and intervention to prevent complications.
Abstract:
Expected clinical manifestations of intussusception include paroxysmal abdominal pain, vomiting, abdominal mass, and with time, rectal bleeding. We report a case where lethargy and vomiting are the presenting complaints. Diagnostic delay was encountered for this infant who had altered sensorium without accompanying pain, melena, or mass on initial examination. Either plain radiographs, supplemented by ultrasonography of the abdomen, or a barium enema should be performed in infants with unexplained lethargy.