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Query: UMLS:C0023380 (lethargy)
 5,697 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Intussusception is an uncommon condition, but it is the most frequent cause of bowel obstruction in infants and children aged 3 months to 5 years. If undiagnosed, it can result in bowel necrosis, perforation, and even death. Four cardinal signs and symptoms (abdominal pain, rectal bleeding, vomiting, and abdominal mass) are described in patients with intussusception, but these manifestations are not always present and their absence may lead to misdiagnosis. Lethargy might be considered a fifth cardinal symptom. As demonstrated in this case, lethargy may be a significant presenting feature in an infant with no history of abdominal pain, and in association with the other cardinal symptoms, it may be an early indication of a significant illness such as intussusception. Awareness of this association may result in an earlier diagnosis and an improved outcome in patients with intussusception.
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PMID:Intussusception. A case that suggests a new cardinal symptom--lethargy. 337 51

Expected clinical manifestations of intussusception include paroxysmal abdominal pain, vomiting, abdominal mass, and with time, rectal bleeding. We report a case where lethargy and vomiting are the presenting complaints. Diagnostic delay was encountered for this infant who had altered sensorium without accompanying pain, melena, or mass on initial examination. Either plain radiographs, supplemented by ultrasonography of the abdomen, or a barium enema should be performed in infants with unexplained lethargy.
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PMID:Intussusception: a supplement to the mnemonic for coma. 361 30

Intussusception remains a leading cause of bowel obstruction in early infancy and childhood. From 1970 to 1985, 83 patients with intussusception were treated. There were 51 boys and 32 girls ranging in age from 2 months to 22 years. Ten patients had a total of 14 separate recurrences; nine occurred during the initial hospitalization. Symptoms on presentation included abdominal pain (80%), palpable mass (60%), rectal bleeding (53%), and lethargy or sepsis (45%). Fifteen children underwent exploration without contrast studies based on duration of symptoms (greater than 5 days) and evidence of severe obstruction on plain abdominal x-ray films. In the remaining children, diagnosis was confirmed by barium enema and hydrostatic reduction was achieved in only 34 patients (42% success rate). Symptoms were present more than 48 hours in 55% of the reduction failures. At operation, five children had spontaneously reduced and an appendectomy was performed. Manual reduction was possible in 32 patients. The intussusception was irreducible in 26 patients, and 18 required temporary stomas. Pathologic lead points were found in 11 patients. Average length of hospitalization was 1.5 days after barium enema reduction, 9.6 days after manual reduction, and 13.8 days after bowel resection. There were no recurrences of intussusception after surgical reduction. A significant morbidity rate was observed with a delay in diagnosis. Adequate preoperative preparation and prompt surgical intervention are associated with 100% survival.
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PMID:Intussusception: current management in infants and children. 366 Feb 43

The author's experience with lethargy in pediatric patients with intussusception was reviewed retrospectively over a 10-year period and proved to be a symptom elicited on admission in half of the patients. The results indicate that lethargy is an important symptom in patients with intussusception when occurring in association with vomiting, melena, or a palpable abdominal mass, or all three.
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PMID:Lethargy as a presenting symptom in patients with intussusception. 370 21

Hospital records were reviewed of almost 1,000 infants and children with intussusception during a 25 year period. Among the approximately 850 who had barium enemas, six had colonic perforations during the attempted hydrostatic barium enema reduction of the intussusception. All occurred in patients 6 months old or less. Most had preceding viral illness, four had pain, all vomited, five had rectal bleeding, and only one had a palpable mass. All were pale, dehydrated, lethargic, and had intermittent mottling of the skin and complete bowel obstruction. All had been ill for over 36 hr. The perforations occurred through areas of necrotic ischemic colon. All infants required a right hemicolectomy. These babies seem to fit a pattern in which they are younger and sicker longer than the average patient with intussusception and have complete bowel obstruction. These facts are a warning that such infants are at increased risk for a barium enema bowel perforation.
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PMID:Perforation of the intussuscepted colon. 697 81

To determine whether childhood intestinal intussusception is associated with elevated plasma beta-endorphin levels, a series of patients was studied prospectively. Fourteen patients (age range between 3 months and 7 years) presented to two university pediatric emergency departments in Chicago with clinical symptoms and signs of intussusception. Venous blood (2cc) was withdrawn for plasma beta-endorphin determination, followed by barium enema. Plasma beta-endorphin levels were measured by radioimmunoassay. The mean beta-endorphin level of the 8 patients with barium enema proven intussusception was 14.1 +/- 12.0 pg/ml. Two of these patients presented with marked lethargy and had beta-endorphin levels of 7.5 and 21.2 pg/ml. The mean plasma beta-endorphin level of the 5 patients with negative barium enema studies was 18.1 +/- 10.0 pg/ml (P = 0.56). A sixth control patient had a plasma beta-endorphin level of 1569 pg/ml. In conclusion, childhood intestinal intussusception is not associated with elevated plasma beta-endorphin levels.
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PMID:Plasma beta-endorphin levels and childhood intussusception. 788 94

Intussusception, the invagination of a portion of the intestine into an adjacent segment, is the most common cause of intestinal obstruction in post neonatal children. Most cases are idiopathic, but in about 2-12% the intussusception evolves secondary to an underlying abnormality. Classically, there is sudden onset of attacks of screaming, accompanied by pallor, vomiting, and irritability in a previously health child. Some gradually become weaker and lethargic. We evaluated variations in presenting symptoms and outcome as related to age and time until admission. There were incidence peaks in the spring and autumn. 48% developed irritability, while 42% were described as apathetic. These results emphasize the importance of awareness that apathy can be a major presenting symptom. The younger the child, the greater the rate of success of reduction by hydrostatic pressure. In those admitted within 24 hours of onset, the rate of reduction was twice that in those admitted later. Awareness of atypical symptoms and early diagnosis may affect treatment and improve prognosis.
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PMID:[Intussusception in infants]. 792 13

This study reviews all childhood intussusceptions treated over a 6 year period in a regional centre with six visiting general surgeons and two paediatricians. Clinical presentation, management, complications and outcomes were noted and an attempt was made to follow up all cases. There were 20 patients, with a median age of 6 months (range 10 weeks to 17 months). Only one patient had all four classical features of intussusception (pain, vomiting, 'red currant jelly' stools and abdominal mass). Seven patients were managed successfully by barium enema reduction, but 14 required operation, four following failed radiological reduction. There was one intestinal perforation due to attempted barium enema reduction and one patient required a reoperation for ileal gangrene following operative reduction. There were no deaths and there have been no subsequent recurrent intussusceptions although three cases were lost to follow up. There was a delay in diagnosis in some cases (average duration from onset to diagnosis was 34 h). Although delay was incurred by parents in some cases and in peripheral hospitals in others, there is a need for greater awareness by surgeons of the significance of subtle features such as pallor and lethargy in a child with persistent vomiting. Delay in diagnosis is likely to lead to an increased need for primary surgical intervention. Adverse features (age > 3 months or < 2 years; symptoms > 24 h; small bowel obstruction; dehydration > 5%) were predictive of an increased likelihood of surgical resection, and may help avoid inappropriate attempts at radiological reduction.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Childhood intussusception in a regional hospital. 794 69

Many reviews have included the salient features of the clinical spectrum of intussusception: abdominal pain, vomiting, bloody stools and abdominal mass. We report a case with atypical presentation of the illness, presenting as altered consciousness. A misdiagnosis and delay of treatment is often associated with increased morbidity. Either plain radiographs, supplemented by ultrasonography of the abdomen, or a barium enema should be performed in infants with unexplained lethargy.
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PMID:[Changes in the consciousness as a manifestation of intestinal intussusception]. 835 19

Intussusception is the invagination of one bowel segment into another. It is an emergent condition that most commonly affects infants between five and nine months of age, but it can also occur in other age groups. The etiology is usually idiopathic in infants five to nine months of age; neonates, older children and adults more commonly have lead points such as a Meckel's diverticulum or a neoplasm. Early diagnosis is essential to avoid treatment delays, which can increase morbidity and mortality. It has been reported that patients with intussusception present with abdominal pain, vomiting and bloody stools, but this classic triad is often absent. More commonly, lethargy and irritability are the presenting signs. A rectal examination, with testing for occult blood, is an important part of the evaluation and is frequently positive. Barium enema is the gold standard for diagnosis and also has therapeutic potential for reducing the intussusception. Ultrasound is an accurate, low-risk screening tool when performed and interpreted by an experienced ultrasonographer. Surgical reduction is performed if nonoperative reduction is contraindicated or unsuccessful, or if a lead point is suspected.
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PMID:Intussusception. 867 37


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