Altered Mental Status as the Primary Presentation of Intussusception in a 3-Month-Old Child Diagnosed by Point-Of-Care Ultrasonography.

BACKGROUND

Intussusception can lead to significant morbidity in affected children secondary to tissue ischemia and necrosis. When a child outside of the classic age range presents with symptoms other than intermittent abdominal pain, the diagnosis of intussusception can be difficult and is often delayed.

CASE REPORT: We present the case of a three-month-old boy who presented to the emergency department with waxing and waning mental status and seizure-like activity who was ultimately diagnosed with intussusception. The effective use of bedside ultrasonography, by the attending pediatric radiologist, enabled an interdisciplinary team to explore abdominal etiologies in parallel with testing for more commonly seen causes of altered mental status. This led to an expedited diagnosis and successful definitive management. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Intussusception is a common pediatric emergency encountered by emergency physicians where a timely diagnosis can have a profound impact on patient outcomes. Previous case reports highlight how easily intussusception can be overlooked with this atypical neurologic presentation. Furthermore, because patients with profound altered mental status are often too ill to leave the emergency department for diagnostic testing, bedside abdominal ultrasonography may be helpful in these patients.