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An unusual presentation of small bowel intussusception

  • Samantha Dankoff (a1), Pramod Puligandla (a2) (a3), Alana Beres (a3) and Farhan Bhanji (a2) (a4)

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.

Un 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’opération 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.

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Copyright

Corresponding author

Correspondence to: Samantha Dankoff, MDCM, Department of Pediatric Emergency, Montreal Children’s Hospital, 2300 Tupper St., Montreal, QC H3H 1P3; Email: samantha.dankoff@mail.mcgill.ca

References

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