Two children with lethargy and intussusception

Hickey, Robert W.; Sodhi, Surinder K; Johnson, Warren R.

doi:10.1016/s0196-0644(05)82343-1

Cited by 22 publications

(11 citation statements)

References 10 publications

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“…8 The clinical presentation having typical triad of severe intermittent abdominal pain, currant jelly stools and vomiting is seen in less than 20% of cases. 9 Bouts of abdominal pain may be evidenced by pulling of knees against the abdomen with an interim asymptomatic healthy child. In ileocolic intussusception palpation of the abdomen may reveal a sausage-shaped mass which is located in the RUQ.…”

Section: Discussionmentioning

confidence: 99%

Multimodalities of Management of Paediatric Ileocolic Intussusception

M¹,

Naveen²,

Tulsi³

et al. 2015

jemds

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Intussusception is a life-threatening illness and occurs when a portion of the intestine folds like a telescope with one segment slipping inside another segment. Hirschsprung was the first to publish a series of reports on successful hydrostatic reduction in 1876. Intussusception remains one of the most commonly encountered paediatric surgical emergencies. Enema reduction still remains the mainstay of non-operative care today. Barium and more recently air contrast enemas have been the initial diagnostic and therapeutic investigation of choice. Successful reduction rates vary widely from 42 to 95% (eee). AIMS AND OBJECTIVES: Aims and objectives of this article with a series of cases of intussusception is to review the various clinical presentation and to study the effectiveness of non-surgical intervention using contrast or AIR enema reduction under fluoroscopic guidance. METHODS AND RESULTS: A prospective study from October 2010 to September 2015 was carried out in hospitals in Bangalore. Complete review of medical records for clinical and demographic information was only performed for those cases fulfilling diagnostic criteria. During the study, A total of 62 patients diagnosed cases were included in this study. Cases identified in the study were similar in presentation and demographics as those observed in other South Asian Countries. These patients were haemodynamically stabilized and were subjected to definitive procedure; enema reduction was tried in all patients. Multimodalities of management included nonoperative reduction that is hydrostatic enema reduction in 2 cases (3.2), barium enema reduction 45 cases (72.5) and air enema recution in 12 cases (19.3), finally 3 cases (4.8) which failed enema reduction were operated. One case (1.61) intussusception -associated death was recorded. CONCLUSION: Surgical intervention in intussusception can be prevented by nonoperative reduction, especially if presented early and no signs of peritonitis.

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Section: Discussionmentioning

confidence: 99%

Multimodalities of Management of Paediatric Ileocolic Intussusception

M¹,

Naveen²,

Tulsi³

et al. 2015

jemds

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“…A wide spectrum of symptoms may range from painless intussusception to constipation, dehydration, diarrhea, intestinal prolapse, rectal bleeding, sepsis, shock, syncope, vomiting and altered mental status (lethargy and irritability). 17 Lethargy is seen most frequent in infants and young children with or without history of gastrointestinal symptoms. Altered mental status has been hypothesized to be secondary to a combination of factors such as dehydration, electrolyte imbalance, and endorphins or toxic metabolic products released from the ischemic bowel which can affect the brain.…”

Section: Discussionmentioning

confidence: 99%

Current Trends in Paediatric Intususceptions

M¹,

Basawaraj²,

Tulsi³

et al. 2015

jemds

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Intussusception is the major cause of acute intestinal obstruction in infants. The classic clinical triad of intussusception is colicky abdominal pain, vomiting and bloody stools. However, only 20% of patients present with this triad. OBJECTIVES: The objective of this article with a series of cases of intussusception is to review the spectrum of clinical presentation of this disease entity and also to study the effectiveness of non-surgical intervention in children with intussusception using barium enema reduction under fluoroscopy. METHODS AND RESULTS: This prospective study spread over a period of 3 year and six months from October 2010 to march 2014 was carried out in tertiary care hospital in south Bangalore. Complete review of medical records for clinical and demographic information was only performed for those cases fulfilling diagnostic certainty (Definite intussusception). During the surveillance period, A total of 40 patients, diagnosed cases were included in this study. The majority (78.4%) of the cases occurred in the first year of life. The male: female ratio was 2.4: 1. Intussusception cases occurred round the year with no distinct seasonality. No intussusception-associated death was recorded. Cases identified in the study were similar in presentation and demographics as those observed in other south East Asian settings. Clinical presentation of the patients were pain abdomen, vomiting, blood in stools, fever and loose stools. Among the patients who were admitted the time between the onset of symptoms and hospitalization was between 36 to 48 hours, After stabilizing them haemodynamically they were subjected to definitive procedure, Barium enema reduction was tried in all patients, exclusion criteria was patients with clinical and radiological sign and symptoms of peritonitis, duration of symptoms more than 30hours and massive abdominal distension. Out of forty cases, thirty seven (81.8%) were reduced by fluoroscopic guided barium enema, those who failed among them, one (2.5) was reduced by pneumatic reduction, one (2.5) was reduced by ultrasound guided pneumatic reduction and only one (2.5%) patient required surgical interventions, reduced manually during surgery. No mortalities were recorded during the study. There was one recurrence noted in our study 15 days after discharge and was subsequently treated with fluoroscopic guided contrast reduction. CONCLUSION: Surgical intervention in intussusception can be prevented by non-operative reduction especially if presented early and no signs of peritonitis.

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“…There have been theories suggesting possible release of endorphins, and toxic metabolites from the compromised gut mucosa 8. Some clinicians have seen a response after administration of naloxone,5 , 8 although other researchers have found endorphin levels in patients with intussusception to be no different from those of controls 9. Rapidly developing dehydration and shock can contribute towards lethargy in the paediatric population.…”

Section: Discussionmentioning

confidence: 99%

Neurological presentation of intussusception: case discussion and literature review

Venkatesha¹

2009

Case Reports

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A previously well, 7-month-old baby boy presented with a 6 h history of lethargy. On examination, he was drowsy and responsive only to painful stimuli (Glasgow Coma Score 9/15). Vital parameters were normal. Detailed systemic examination was normal. The patient was commenced on antibiotics in view of non-specific findings of lethargy in an infant. A few hours later, the mother reported an episode of uprolling of eyes with jerking of limbs. An array of investigations to rule out meningoencephalitis, toxic ingestion, sepsis, metabolic disease and intracranial pathology were within normal limits. The following day the patient passed stools with a few fresh blood stains. He was noted to have a 2×3 cm mass in the left upper quadrant of the abdomen. Abdominal x ray and ultrasound were undertaken to rule out intussusception, and were reported as normal. However, in view of the high index of suspicion for intussusception, the patient was transferred to a tertiary hospital for further evaluation and management. He continued to be lethargic, and a repeat ultrasound at the tertiary hospital revealed intussusception. The patient underwent laparoscopic hemicolectomy as air reduction was unsuccessful. The postoperative course was uneventful and the infant made a complete recovery.

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Two children with lethargy and intussusception

Cited by 22 publications

References 10 publications

Multimodalities of Management of Paediatric Ileocolic Intussusception

Multimodalities of Management of Paediatric Ileocolic Intussusception

Current Trends in Paediatric Intususceptions

Neurological presentation of intussusception: case discussion and literature review

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