Atypical intussusception in infants

Abstract

Introduction: Intussusception constitutes a surgical emergency and it is also the most frequent cause of intestinal occlusion in infants and in children under 2 years of age. It is defined as the introduction of a segment of intestine and its mesentery into another, in a telescopic way. It should be highly suspected in order to make a timely diagnosis and avoid serious complications. This work is based on the presentation of a clinical case that shows an atypical form of this condition.

Objective: To describe intervention in children with intussusception secondary to mesenteric lymphadenopathy.

Case presentation: Male infant 6 months old, white, from a rural area, with a history of upper respiratory infection (common cold) 10 days before, eutrophic, who was brought to the emergency area because of lethargy and bilious vomiting. Physical examination: Lethargic infant who opens his eyes in response to stimuli. Weak cry. Abdomen slightly distended, soft, no visceromegaly, no peritoneal reaction, no abdominal tumor palpable. Rectal examination was performed where tonic sphincter and empty rectal ampulla were found. During abdominal ultrasound, an image suggestive of intestinal intussusception was detected and a presumptive diagnosis was established. During surgery the diagnosis was confirmed and the presence of mesenteric adenopathies was detected as a triggering factor.

Conclusions: Intussusception should always be suspected in any infant presenting viral infection with lethargy and bilious vomiting, because the lymphadenopathies which are in the mesentery may hypertrophy and act as an invaginating head, causing intussusception. Timely diagnosis and proper management can prevent serious complications, even death.