Neurological manifestations of intussusceptions in a group of patients aged below 5 years

Abstract

Background: Intussusception occurs when a portion of the alimentary tract is telescoped into an adjacent segment. It is a one cause of intestinal obstruction between 3 months and 6years of age. The majority of cases in children are idiopathic.
Objectives: To study the nature of neurological signs and symptoms and to describe the characteristics of the patients presenting in this a typical way.

Methodology: Patients aged 3mo-5yr with signs and symptoms consistent with intussusception admitted to Al-Zahra's teaching hospital in the 1st Feb. 2009 to the 31st of July 2010.History was taken including; name, sex, age, duration of illness, clinical manifestation, examination, erect plain abdominal X-ray and abdominal
ultrasound. Data were collected to evaluate clinical manifestation (Abdominal pain, vomiting, bloody stool), neurological symptoms(lethargy, convulsion, fluctuating consciousness). abdominal X-ray and ultrasound as guidance for diagnosis of intussusceptions in children.. Barium enema was not done because of lack facilities.

Results: (68) patients were studied, their mean age was (9) months. Males were more than females with a male: female ratio of 1.4:1. Most of patients presented with abdominal pain, vomiting, blood in stool. While lethargy (66%), convulsion (10%), and fluctuating consciousness (24%). During examination a red current jelly stool (89.7%) and abdominal mass was found in (52.9%) of cases. We found that most common sign detected by abdominal ultrasound was the presence of abdominal mass (63%), further more ultrasound can be used to detect peritonitis. X-ray was done in all patients (100%), but it was inconclusive in most cases 71%.

Conclusions: Intussusception is more common in boys than in girls. Trait of Abdominal pain, vomiting, blood in stool are commonest presentation. Intussusception should be considered in the differential diagnosis in young children presenting with lethargy, convulsion and/or sudden alteration of consciousness(main complain) even in the absence of one or more classical symptom of intussusception., ultrasound of abdomen are useful methods in the diagnosis.