Dramatic neurological signs in children with intussusception

Introduction: Especially in young children, neurological signs such as lethargy, reclined neck, and cerebral convulsions can dominate the clinical symptoms in intussusception. An ultrasound without pathological findings (ua) could be a pitfall.

Case Report: A 22-month-old child with recurrent vomiting and reduced general condition. Vital signs intact, Temp. 36.8 °C (rect), GCS 10, pale, Turgor reduced. Cardio-pulmonal situation (ua). Abdomen soft, peristaltic sounds rare, no abdominal pain, no muscular defense; palpable abdominal mass in the right upper abdominal region. Normal defecation, no rectal blood, no symptoms of pain; the day before head trauma in the bathtub. Diagnostic investigation: Laboratory. Diagnostic, cerebral fluid, abdominal ultrasound (exclusion of an intussusception), transcranial cerebral ultrasound, EEG and cCT (ua). Therapy with an infusion of glucose and electrolyte because of the dehydration. Aciclovir and Cefotaxim in strong suspicion of encephalitis. Increasing of somnolence, strong reclination of the neck. Under therapy improvement of the general conditions reduced vomiting. After 22 hour progressively lethargy, long-lasting generalized tonic-clonic convulsions and hematemesis. Sodium reduced (124 mmol/l), EEG unspecific, cMRI and Tox-screening (ua). 10 hours later, for the first time, rectal bleeding. Now in the abdominal ultrasound intussusception. Invasive surgery with a resection. Rapid improvement of the neurological symptoms. Discussion: Therefore, intussusception should be considered in young children with neurological symptoms in the differential diagnosis. The clinical picture may be nontypical. Even in the absence of typical signs in the ultrasound. There is still the question how an intussusception can cause such dramatically neurological symptoms (gut to brain axis).