An unusual presentation of small bowel intussusception

Abstract

A previously healthy 2-year-old boy presented to the emergency department with a decreased level of consciousness. A physical examination was unremarkable except for miosis and atypical limb movements. The patient underwent an extensive workup, including the search for metabolic, infectious, neurologic, and toxicologic etiologies. An abdominal ultrasound was performed because the child continued to remain neurologically impaired with no cause identified on other investigations. The ultrasound revealed a persistent uncomplicated ileoileal intussusception. The patient was taken to the operating room for surgical reduction. The child recovered fully postoperatively. This case illustrates the rare presentation of intussusception encephalopathy, which can be a diagnostic dilemma, especially when none of the symptoms of intussusception are present. Endogenous opioid poisoning is hypothesized to be the cause of the miosis and may hint at the diagnosis and aid in early management. RÉSUMÉUn petit garçon de deux ans, auparavant en bonne santé, a été conduit au service des urgences (SU) pour une altération de l'état de conscience. Il n'y avait rien à signaler à l'examen physique, à part un myosis et des mouvements anormaux des membres. Des examens approfondis ont été effectués, dont certains visaient la recherche de causes métaboliques, infectieuses, neurologiques ou toxiques. Une échographie abdominale a été réalisée pendant que l'enfant était toujours dans un état neurologique altéré, et ce, sans qu'aucune cause n'ait pu être décelée par d'autres examens. L'échographie a montré une invagination iléo-iléale persistante, sans complications. L'enfant a été conduit à la salle d'opéra-tion pour une réduction de la malformation, puis s'est complètement rétabli après l'intervention. Voilà un bel exemple d'« encéphalopathie par invagination », qui peut poser un dilemme diagnostique, surtout en l'absence de tout symptôme d'invagination. On a supposé qu'un empoisonnement à des opioïdes endogènes était à l'origine du myosis, et cela a pu avoir contribué à la pose du diagnostic et à la prise en charge précoce de l'affection.

An Unusual Neurological Form of Acute Intussusception in an Infant: Late Diagnosis and Management

“…While most cases report required surgical reduction [7–9], in our case the patient underwent a surgical reduction with good outcome.…”

“…Pathophysiology of altered mental status is not yet clear [7]. Conway shares the opinion of action on a nervous system that is particularly receptive to various neuromediators (endotoxins, intestinal neurohormones, endorphins, etc.)…”

“…Endogenous opioid poisoning is hypothesized to be the cause of the miosis and may hint at the diagnosis and aid in early management [7], but miosis is not always present, and the effectiveness of naloxone is very inconsistent and in any case difficult to interpret in the context of fluctuating consciousness disorders [10].…”

Lethargy as an initial symptom of intussusception secondary to Meckel's diverticulum in a 2.5 year-old girl: Case report

“…Intussusception is the commonest cause of bowel obstruction in children under 2 years of age. It occurs in 1.4 per 1000 live births.10 Intussusception is a rare presentation, being the first case reported by Goetting in the year 1990.11 It is characterized by the telescoping of one segment of bowel (intussusceptum) into its neighboring segment (intussuscepiens), situated most commonly near the ileo-cecal valve (ileocolic) [ 7 ].…”

Encephalopathy an Atypical Presentation of Intussusception: A Case Report

“…2 It is characterized by the telescoping of one segment of bowel (intussusceptum) into its neighboring segment (intussuscepiens), situated most commonly near the ileo-cecal valve (ileocolic). 3 Children suffering from this emergency condition will not show its cardinal symptoms. It is often confused with sepsis until blood and stool cultures result in sterile growth and detected by ultrasonography.…”