title: Painless intussusception and altered mental status.
abstract: A 7-month-old child presented to the emergency department (ED) with 2 hours of painless, nonprojectile emesis and a normal mental status. Over a 3-hour period in the ED, the child remained pain-free, but developed hematemesis, hematochezia, and lethargy, progressing to unresponsiveness. The patient was evaluated for toxic ingestion, intracranial bleed, sepsis/meningitis, and intraabdominal pathology. The diagnosis was made by an abdominal ultrasound, which demonstrated an ileal-cecal intussusception that ultimately required surgical reduction. This case illustrates an insidious and poorly understood presentation of a common childhood affliction, as well as the utility of abdominal ultrasound in evaluating a hemodynamically stable patient with intussusception.
authors.affiliation: Department of Emergency Medicine, New York Methodist Hospital, Brooklyn 11215, USA.
authors.forename: R
authors.initials: R
authors.lastname: Birkhahn
authors.forename: M
authors.initials: M
authors.lastname: Fiorini
authors.forename: T J
authors.initials: TJ
authors.lastname: Gaeta
mesh_terms: D003243:Consciousness / Q000502:physiology; D003937:Diagnosis, Differential; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006396:Hematemesis / Q000209:etiology; D006801:Humans; D007077:Ileal Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D007080:Ileocecal Valve / Q000000981:diagnostic imaging / Q000601:surgery; D007223:Infant; D007443:Intussusception / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D012894:Sleep Stages / Q000502:physiology*; D014463:Ultrasonography; D014474:Unconsciousness / Q000209:etiology; D014839:Vomiting / Q000209:etiology