Intussusception history and symptoms: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Intussusception}} | {{Intussusception}} | ||
{{CMG}} | {{CMG}}; {{AE}} {{SSW}} | ||
==Overview== | ==Overview== | ||
A positive history of [[abdominal pain]], [[Nausea and vomiting|vomiting]], [[rectal bleeding]], and [[lethargy]] is suggestive of intussusception. Presentation of intussusception is very variable. Suspicion for intussusception should be kept on a high index, especially in children aged 3 months to 36 months (peak age of presentation). Obtaining history about different causes of [[symptoms]] like [[fever]], exposure to toxins, and ill contacts. Common [[symptoms]] include [[pain]], inconsolable crying ([[baby colic]]), drawing up of legs, [[vomiting]], [[abdominal mass]], [[bloody stools]], and current jelly [[stools]]. There can be intermittent [[pain]] free intervals in between episodes of [[pain]] which can be confused with an episode of [[gastroenteritis]]. The classic triad of [[pain]], sausage-shaped [[abdominal mass]] and currant jelly stool are only seen in 15% of initial patient presentation. Atypically patients might present with only [[abdominal pain]] and [[lethargy]]. Intussusception should be kept in mind in an [[infant]] presenting with [[lethargy]] or [[Altered sensorium|altered consciousness]] alone. | |||
==History== | ==History== | ||
Patients with intussusception may have a positive history of: | Patients with intussusception may have a positive history of: | ||
* Abdominal pain which can either be intermittent, severe, crampy, or progressive | * [[Abdominal pain]] which can either be intermittent, severe, crampy, or progressive | ||
* Vomiting | * [[Nausea and vomiting|Vomiting]] | ||
* Gross or occult | * Gross or occult [[rectal bleeding]] | ||
* Lethargy which is often episodic | * [[Lethargy]] which is often episodic | ||
Presentation of intussusception is | Presentation of intussusception is variable. Suspicion for intussusception should be kept on a high index, especially in children aged 3 months to 36 months (peak age of presentation). But, intussusception might occur in other age groups as well. | ||
Obtaining history about different | Obtaining history about different [[symptoms]] is also important, such as: | ||
* Fever - may signify | * [[Fever]] - may signify [[gastroenteritis]], [[appendicitis]] and infection | ||
* Exposure to toxins - medications, alcohol or poison | * Exposure to toxins - medications, [[alcohol]] or poison | ||
* Ill contacts - gastroenteritis | * Ill contacts - [[gastroenteritis]] | ||
Common symptoms of | Common [[symptoms]] of intussusception include: | ||
* Pain: | * Pain: A toddler or [[infant]] presenting with crampy [[abdominal pain]] with or without [[rectal bleeding]] | ||
* | *Inconsolable crying ([[baby colic]]) | ||
* Drawing up of the legs toward the abdomen<ref name="pmid22929138">{{cite journal |vauthors=Mandeville K, Chien M, Willyerd FA, Mandell G, Hostetler MA, Bulloch B |title=Intussusception: clinical presentations and imaging characteristics |journal=Pediatr Emerg Care |volume=28 |issue=9 |pages=842–4 |year=2012 |pmid=22929138 |doi=10.1097/PEC.0b013e318267a75e |url=}}</ref> | * Drawing up of the legs toward the [[abdomen]]<ref name="pmid22929138">{{cite journal |vauthors=Mandeville K, Chien M, Willyerd FA, Mandell G, Hostetler MA, Bulloch B |title=Intussusception: clinical presentations and imaging characteristics |journal=Pediatr Emerg Care |volume=28 |issue=9 |pages=842–4 |year=2012 |pmid=22929138 |doi=10.1097/PEC.0b013e318267a75e |url=}}</ref> | ||
* Episode occur with 15-20 min intervals | * Episode occur with 15-20 min intervals | ||
* Vomiting usually occurs after the first episode. Initially the vomiting is non-bilious but may convert to bilious as the obstruction progresses | * [[Vomiting]] usually occurs after the first episode. Initially the [[vomiting]] is non-[[bilious]] but may convert to [[bilious]] as the obstruction progresses | ||
* An abdominal mass (sausage shaped), may be palpated in the right side of abdomen | * An [[abdominal mass]] (sausage shaped), may be palpated in the right side of [[abdomen]] | ||
* Bloody stool or even occult blood<ref name="pmid1985640">{{cite journal |vauthors=Losek JD, Fiete RL |title=Intussusception and the diagnostic value of testing stool for occult blood |journal=Am J Emerg Med |volume=9 |issue=1 |pages=1–3 |year=1991 |pmid=1985640 |doi= |url=}}</ref> | * [[Gastrointestinal bleeding|Bloody stool]] or even occult [[blood]]<ref name="pmid1985640">{{cite journal |vauthors=Losek JD, Fiete RL |title=Intussusception and the diagnostic value of testing stool for occult blood |journal=Am J Emerg Med |volume=9 |issue=1 |pages=1–3 |year=1991 |pmid=1985640 |doi= |url=}}</ref> | ||
* Current jelly stools which are a mixture of mucous and blood. (This is seen in minority of patients and is a late finding) | * Current jelly [[stools]] which are a mixture of [[mucous]] and [[blood]]. (This is seen in minority of patients and is a late finding) | ||
* There can be intermittent pain free intervals in between episodes of pain. | * There can be intermittent pain free intervals in between episodes of [[pain]]. This may be confused with an episode of [[gastroenteritis]]<ref name="pmid3660243">{{cite journal |vauthors=West KW, Stephens B, Vane DW, Grosfeld JL |title=Intussusception: current management in infants and children |journal=Surgery |volume=102 |issue=4 |pages=704–10 |year=1987 |pmid=3660243 |doi= |url=}}</ref> | ||
The classic triad of pain, sausage-shaped abdominal mass and currant jelly stool are only seen in 15% of initial patient presentation<ref name="pmid3660243">{{cite journal |vauthors=West KW, Stephens B, Vane DW, Grosfeld JL |title=Intussusception: current management in infants and children |journal=Surgery |volume=102 |issue=4 |pages=704–10 |year=1987 |pmid=3660243 |doi= |url=}}</ref><ref name="pmid9148991">{{cite journal |vauthors=Yamamoto LG, Morita SY, Boychuk RB, Inaba AS, Rosen LM, Yee LL, Young LL |title=Stool appearance in intussusception: assessing the value of the term "currant jelly" |journal=Am J Emerg Med |volume=15 |issue=3 |pages=293–8 |year=1997 |pmid=9148991 |doi= |url=}}</ref> | The classic triad of pain, sausage-shaped [[abdominal mass]] and currant jelly stool are only seen in 15% of initial patient presentation<ref name="pmid3660243">{{cite journal |vauthors=West KW, Stephens B, Vane DW, Grosfeld JL |title=Intussusception: current management in infants and children |journal=Surgery |volume=102 |issue=4 |pages=704–10 |year=1987 |pmid=3660243 |doi= |url=}}</ref><ref name="pmid9148991">{{cite journal |vauthors=Yamamoto LG, Morita SY, Boychuk RB, Inaba AS, Rosen LM, Yee LL, Young LL |title=Stool appearance in intussusception: assessing the value of the term "currant jelly" |journal=Am J Emerg Med |volume=15 |issue=3 |pages=293–8 |year=1997 |pmid=9148991 |doi= |url=}}</ref> | ||
=== Atypical | === Atypical symptoms === | ||
* Up to 1/5th patients do not present with the triad of pain, abdominal mass and current jelly stools. They may present with only pain and no other symptoms<ref name="pmid3660243">{{cite journal |vauthors=West KW, Stephens B, Vane DW, Grosfeld JL |title=Intussusception: current management in infants and children |journal=Surgery |volume=102 |issue=4 |pages=704–10 |year=1987 |pmid=3660243 |doi= |url=}}</ref><ref name="pmid9148991">{{cite journal |vauthors=Yamamoto LG, Morita SY, Boychuk RB, Inaba AS, Rosen LM, Yee LL, Young LL |title=Stool appearance in intussusception: assessing the value of the term "currant jelly" |journal=Am J Emerg Med |volume=15 |issue=3 |pages=293–8 |year=1997 |pmid=9148991 |doi= |url=}}</ref> | * Up to 1/5th patients do not present with the triad of [[abdominal pain]], [[abdominal mass]] and current jelly stools. They may present with only pain and no other [[symptoms]]<ref name="pmid3660243">{{cite journal |vauthors=West KW, Stephens B, Vane DW, Grosfeld JL |title=Intussusception: current management in infants and children |journal=Surgery |volume=102 |issue=4 |pages=704–10 |year=1987 |pmid=3660243 |doi= |url=}}</ref><ref name="pmid9148991">{{cite journal |vauthors=Yamamoto LG, Morita SY, Boychuk RB, Inaba AS, Rosen LM, Yee LL, Young LL |title=Stool appearance in intussusception: assessing the value of the term "currant jelly" |journal=Am J Emerg Med |volume=15 |issue=3 |pages=293–8 |year=1997 |pmid=9148991 |doi= |url=}}</ref> | ||
* Some patients might just present with lethargy or altered consciousness and no other symptoms that suggest abdominal pathology. This presentation primarily occurs in infants mostly and may be confused with sepsis<ref name="pmid15258874">{{cite journal |vauthors=Pumberger W, Dinhobl I, Dremsek P |title=Altered consciousness and lethargy from compromised intestinal blood flow in children |journal=Am J Emerg Med |volume=22 |issue=4 |pages=307–9 |year=2004 |pmid=15258874 |doi= |url=}}</ref><ref name="pmid2073304">{{cite journal |vauthors=Goetting MG, Tiznado-Garcia E, Bakdash TF |title=Intussusception encephalopathy: an underrecognized cause of coma in children |journal=Pediatr. Neurol. |volume=6 |issue=6 |pages=419–21 |year=1990 |pmid=2073304 |doi= |url=}}</ref><ref name="pmid450570">{{cite journal |vauthors=Singer J |title=Altered consciousness as an early manifestation of intussusception |journal=Pediatrics |volume=64 |issue=1 |pages=93–5 |year=1979 |pmid=450570 |doi= |url=}}</ref><ref name="pmid19673722">{{cite journal |vauthors=Kleizen KJ, Hunck A, Wijnen MH, Draaisma JM |title=Neurological symptoms in children with intussusception |journal=Acta Paediatr. |volume=98 |issue=11 |pages=1822–4 |year=2009 |pmid=19673722 |doi=10.1111/j.1651-2227.2009.01466.x |url=}}</ref><ref name="pmid22512486">{{cite journal |vauthors=Sassower KC, Allister LM, Westra SJ |title=Case records of the Massachusetts General Hospital. Case 12-2012. A 10-month-old girl with vomiting and episodes of unresponsiveness |journal=N. Engl. J. Med. |volume=366 |issue=16 |pages=1527–36 |year=2012 |pmid=22512486 |doi=10.1056/NEJMcpc1103563 |url=}}</ref> | * Some patients might just present with [[lethargy]] or [[Altered sensorium|altered consciousness]] and no other [[symptoms]] that suggest [[abdominal]] pathology. This presentation primarily occurs in infants mostly and may be confused with [[sepsis]]<ref name="pmid15258874">{{cite journal |vauthors=Pumberger W, Dinhobl I, Dremsek P |title=Altered consciousness and lethargy from compromised intestinal blood flow in children |journal=Am J Emerg Med |volume=22 |issue=4 |pages=307–9 |year=2004 |pmid=15258874 |doi= |url=}}</ref><ref name="pmid2073304">{{cite journal |vauthors=Goetting MG, Tiznado-Garcia E, Bakdash TF |title=Intussusception encephalopathy: an underrecognized cause of coma in children |journal=Pediatr. Neurol. |volume=6 |issue=6 |pages=419–21 |year=1990 |pmid=2073304 |doi= |url=}}</ref><ref name="pmid450570">{{cite journal |vauthors=Singer J |title=Altered consciousness as an early manifestation of intussusception |journal=Pediatrics |volume=64 |issue=1 |pages=93–5 |year=1979 |pmid=450570 |doi= |url=}}</ref><ref name="pmid19673722">{{cite journal |vauthors=Kleizen KJ, Hunck A, Wijnen MH, Draaisma JM |title=Neurological symptoms in children with intussusception |journal=Acta Paediatr. |volume=98 |issue=11 |pages=1822–4 |year=2009 |pmid=19673722 |doi=10.1111/j.1651-2227.2009.01466.x |url=}}</ref><ref name="pmid22512486">{{cite journal |vauthors=Sassower KC, Allister LM, Westra SJ |title=Case records of the Massachusetts General Hospital. Case 12-2012. A 10-month-old girl with vomiting and episodes of unresponsiveness |journal=N. Engl. J. Med. |volume=366 |issue=16 |pages=1527–36 |year=2012 |pmid=22512486 |doi=10.1056/NEJMcpc1103563 |url=}}</ref> | ||
* Intussusception should be kept in mind in an infant presenting with lethargy or altered consciousness alone | * Intussusception should be kept in mind in an [[infant]] presenting with [[lethargy]] or [[Altered sensorium|altered consciousness]] alone | ||
==References== | ==References== | ||
Latest revision as of 16:11, 9 January 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sargun Singh Walia M.B.B.S.[2]
Overview
A positive history of abdominal pain, vomiting, rectal bleeding, and lethargy is suggestive of intussusception. Presentation of intussusception is very variable. Suspicion for intussusception should be kept on a high index, especially in children aged 3 months to 36 months (peak age of presentation). Obtaining history about different causes of symptoms like fever, exposure to toxins, and ill contacts. Common symptoms include pain, inconsolable crying (baby colic), drawing up of legs, vomiting, abdominal mass, bloody stools, and current jelly stools. There can be intermittent pain free intervals in between episodes of pain which can be confused with an episode of gastroenteritis. The classic triad of pain, sausage-shaped abdominal mass and currant jelly stool are only seen in 15% of initial patient presentation. Atypically patients might present with only abdominal pain and lethargy. Intussusception should be kept in mind in an infant presenting with lethargy or altered consciousness alone.
History
Patients with intussusception may have a positive history of:
- Abdominal pain which can either be intermittent, severe, crampy, or progressive
- Vomiting
- Gross or occult rectal bleeding
- Lethargy which is often episodic
Presentation of intussusception is variable. Suspicion for intussusception should be kept on a high index, especially in children aged 3 months to 36 months (peak age of presentation). But, intussusception might occur in other age groups as well.
Obtaining history about different symptoms is also important, such as:
- Fever - may signify gastroenteritis, appendicitis and infection
- Exposure to toxins - medications, alcohol or poison
- Ill contacts - gastroenteritis
Common symptoms of intussusception include:
- Pain: A toddler or infant presenting with crampy abdominal pain with or without rectal bleeding
- Inconsolable crying (baby colic)
- Drawing up of the legs toward the abdomen[1]
- Episode occur with 15-20 min intervals
- Vomiting usually occurs after the first episode. Initially the vomiting is non-bilious but may convert to bilious as the obstruction progresses
- An abdominal mass (sausage shaped), may be palpated in the right side of abdomen
- Bloody stool or even occult blood[2]
- Current jelly stools which are a mixture of mucous and blood. (This is seen in minority of patients and is a late finding)
- There can be intermittent pain free intervals in between episodes of pain. This may be confused with an episode of gastroenteritis[3]
The classic triad of pain, sausage-shaped abdominal mass and currant jelly stool are only seen in 15% of initial patient presentation[3][4]
Atypical symptoms
- Up to 1/5th patients do not present with the triad of abdominal pain, abdominal mass and current jelly stools. They may present with only pain and no other symptoms[3][4]
- Some patients might just present with lethargy or altered consciousness and no other symptoms that suggest abdominal pathology. This presentation primarily occurs in infants mostly and may be confused with sepsis[5][6][7][8][9]
- Intussusception should be kept in mind in an infant presenting with lethargy or altered consciousness alone
References
- ↑ Mandeville K, Chien M, Willyerd FA, Mandell G, Hostetler MA, Bulloch B (2012). "Intussusception: clinical presentations and imaging characteristics". Pediatr Emerg Care. 28 (9): 842–4. doi:10.1097/PEC.0b013e318267a75e. PMID 22929138.
- ↑ Losek JD, Fiete RL (1991). "Intussusception and the diagnostic value of testing stool for occult blood". Am J Emerg Med. 9 (1): 1–3. PMID 1985640.
- ↑ 3.0 3.1 3.2 West KW, Stephens B, Vane DW, Grosfeld JL (1987). "Intussusception: current management in infants and children". Surgery. 102 (4): 704–10. PMID 3660243.
- ↑ 4.0 4.1 Yamamoto LG, Morita SY, Boychuk RB, Inaba AS, Rosen LM, Yee LL, Young LL (1997). "Stool appearance in intussusception: assessing the value of the term "currant jelly"". Am J Emerg Med. 15 (3): 293–8. PMID 9148991.
- ↑ Pumberger W, Dinhobl I, Dremsek P (2004). "Altered consciousness and lethargy from compromised intestinal blood flow in children". Am J Emerg Med. 22 (4): 307–9. PMID 15258874.
- ↑ Goetting MG, Tiznado-Garcia E, Bakdash TF (1990). "Intussusception encephalopathy: an underrecognized cause of coma in children". Pediatr. Neurol. 6 (6): 419–21. PMID 2073304.
- ↑ Singer J (1979). "Altered consciousness as an early manifestation of intussusception". Pediatrics. 64 (1): 93–5. PMID 450570.
- ↑ Kleizen KJ, Hunck A, Wijnen MH, Draaisma JM (2009). "Neurological symptoms in children with intussusception". Acta Paediatr. 98 (11): 1822–4. doi:10.1111/j.1651-2227.2009.01466.x. PMID 19673722.
- ↑ Sassower KC, Allister LM, Westra SJ (2012). "Case records of the Massachusetts General Hospital. Case 12-2012. A 10-month-old girl with vomiting and episodes of unresponsiveness". N. Engl. J. Med. 366 (16): 1527–36. doi:10.1056/NEJMcpc1103563. PMID 22512486.