Neurological presentation of intussusception: case discussion and literature review

Summary

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.