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[Lethargic form of acute intestinal intussusception in an infant]
M M d'Escrienne1, P Velin, P Filippigh
1Centre médical infantile, hôpital pour Enfants, Nice, France.
Insights
Intussusception encephalopathy can present with severe neurological symptoms like lethargy, masking typical intestinal signs. Early diagnosis via imaging is crucial for prompt treatment of this rare condition.
Area of Science:
- Pediatric Neurology
- Gastroenterology
Background:
- Intussusception encephalopathy is a rare condition where neurological symptoms dominate, often misdirecting diagnosis.
- Classical intestinal signs of intussusception may be obscured by severe neurological manifestations.
Observation:
- A 21-month-old infant presented with fluctuating consciousness and apathy, followed by vomiting.
- Initial investigations for dehydration, meningitis, encephalitis, and poisoning were negative.
- Abdominal tenderness led to ultrasonography, revealing a sausage-shaped mass indicative of ileocolic intussusception.
Findings:
- The infant's presentation mimicked encephalopathy, with lethargy and vomiting overshadowing gastrointestinal symptoms.
- Ileocolic intussusception was successfully treated with a gas enema.
Implications:
- This case highlights the importance of considering intussusception in infants with unexplained neurological symptoms and vomiting.
- The presentation suggests a possible link to endogenous opioid release during severe pain, warranting further investigation into neuro-gastrointestinal interactions.
Background:
Intussusception encephalopathy, a misleading form in which neurological symptoms are obvious, is classic but rarely described.
Case Report:
A 21 month-old infant was admitted because he had suffered from fluctuating consciousness and apathy for a few hours. Vomiting occurred soon afterwards. Search for dehydration, meningitis, encephalitis, poisoning... was negative; the abdomen was tender leading to ultrasonography that showed a sausage-shaped tumor. The ileocolic intussusception was successfully reduced with a gas enema.
Conclusion:
A striking degree of lethargy associated with vomiting may overshadow to a considerable extent the classical intestinal manifestations. A possible endogenous opioid poisoning by massive secretion of endorphins during pain's paroxysm is one of the hypotheses explaining this type of presentation.