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

A case of intussusception in a 6 month old with lethargy as the initial and predominant system is presented. Children presented to the Emergency Department with otherwise unexplained lethargy should have intussusception as part of the differential diagnosis. A plain film of the abdomen should be obtained. A rectal exam should be done, and a stool checked for occult blood. Radiologic and surgical consultation should be sought simultaneously. Delay in diagnosis and treatment may be associated with decreased success rates of reduction by barium enema, and increased rates of complications of perforation, peritonitis, sepsis, and death.
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PMID:Intussusception presenting as lethargy in a 6-month-old infant. 195 81

A retrospective review was performed to determine the diagnostic value of testing for occult blood in stool of children suspect for intussusception. Ninety-six children had barium enema studies for suspected intussusception. Of the 57 children who had barium enema confirmed intussusception, 29 did not have history or physical findings of gross blood per rectum. Stool was tested for occult blood in 16 of these 29 patients, and 12 (75%) were positive. In comparison, three (20%) of the children who did not have intussusception had stool positive for occult blood. Stool with occult blood was significantly associated with intussusception (P less than .002). The only other clinical factor significantly associated with intussusception was abdominal mass (P less than .02). Vomiting, episodic irritability, poor feeding, abdominal pain and lethargy were not significantly different in the two groups. In conclusion, the authors suggest stool testing for occult blood when evaluating children who present with nonspecific signs and symptoms supportive of intussusception.
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PMID:Intussusception and the diagnostic value of testing stool for occult blood. 198 40

A consecutive series of 385 patients with intussusception treated between January 1, 1982 and December 31, 1987 was analysed. Male patients predominated over female by a ratio of 2.2:1. Seventy nine per cent of patients were under 12 months of age. There was no seasonal variation in the incidence of intussusception. Rectal bleeding was the most common symptom, followed closely by intermittent abdominal pain and vomiting. The duration of symptoms at the time of admission was less than 24 hours in 62%. Barium enema reduction was used initially in most patients. Successful reduction by barium enema alone was obtained in 66% of patients. Thirty two patients experienced recurrence of intussusception, six following operative reduction and 26 following barium enema reduction. Five patients experienced two recurrences each. Several factors including the age of the patients, the presence of a palpable mass, lethargy and abdominal distension were identified as influencing the success rate of barium enema reduction.
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PMID:Intussusception in infancy and childhood. Analysis of 385 cases. 275 20

A three-month-old infant presented with vomiting, lethargy, and hypertension. Abdominal ultrasound suggested the diagnosis of intussusception, which was confirmed by barium enema. Hypertension, previously unreported with intussusception, only resolved after surgical resection of the lesion.
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PMID:Intussusception associated with transient hypertension. 306 37

Intestinal obstruction is a common postoperative complication and is usually related to peritoneal adhesion formation. A less well-recognized cause is postoperative intussusception (POI). Thirty-six instances of POI in children (aged 1 month to 18 years) were treated between 1970 and 1987. POI followed Nissen fundoplication in 9 patients, neuroblastoma resection in 5, small-bowel procedures in 4, inguinal herniorrhaphy in 3, pull-through procedures in 3, ureterostomy in 2, thoracic procedures in 2, ventral hernia in 1, nephrectomy in 1, hepatic resection in 1, Heller myotomy in 1, ventriculo-atrial shunt in 1, and gastrocystoplasty in 1. Initial symptoms included bilious vomiting or increased nasogastric drainage (after initial return of gut function) in 26 patients, abdominal distension in 24, irritability in 10, intermittent pain in 7, palpable abdominal mass in 2, rectal bleeding in 2, and lethargy in 1. The symptoms occurred 1 to 24 days (mean, 8 days) after the initial surgery. Plain abdominal radiographs revealed multiple air-fluid levels in 31 and an "adynamic ileus" in five patients. Barium contrast techniques could successfully reduce two ileocolic and one distal ileo-ileal lesions. The remainder necessitated operative management. Manual reduction was possible in 29 cases, and four children with diagnostic delay required bowel resection and an anastomosis for intestinal necrosis. The site of intussusception was ileo-ileal in 23 patients, jejunojejunal in 6, ileocolic in 5, and jejuno-ileal in 2. The diagnosis of POI should be considered in children with signs of bowel dysfunction in the early postoperative period. Contrast studies are of limited value, since most cases are confined to the small bowel. A high index of suspicion and prompt laparotomy will usually allow manual reduction of the lesion. Diagnostic delay may result in bowel necrosis.
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PMID:Postoperative intussusception: experience with 36 cases in children. 317 73

A case of lactobezoar is described in a toddler with an acute history of abdominal pain, vomiting, and lethargy. Despite normal dietary habits, he had developed a gastric milk coagulum which led to a palpable epigastric tumor. Intussusception was suspected but disproven by barium enema. In retrospect, plain abdominal radiographs demonstrated characteristic mottled filling defects in the stomach from a lactobezoar. Conservative therapy led to prompt disintegration of the lactobezoar.
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PMID:Lactobezoar causing an abdominal triad of colicky pain, emesis, and mass. 318 25

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

A 45-year-old Italian woman, who was admitted to the Royal Free Hospital in London, England, with a 14-day history of general malaise, lethargy, epigastric pain after meals, and night sweats, had had an IUD inserted 13 years earlier which had not been changed. The patient was pyrexial on examination; she had a temperature of 38 degrees Centigrade but no jaundice or enlarged lymph nodes. There was mild epigastric tenderness, and a tender indurated rectal stricture involving the posterior fornix of the vagina was palpable on pelvic examination. The rectal stricture was confirmed on sigmoidoscopy. The biopsy revealed a chronic inflammatory cell infiltrate with lymphocytes, extending from the submucosa through to the muscularis mucosae. A preoperative barium enema showed a long irregular rectal stricture. A large mass of inflammatory tissue was found adherent to the uterus, rectum, fallopian tubes, and ovaries at laparotomy. Bilateral retrograde ureterograms showed complete obstructions of the left ureter at 5 cm and a long irregular stricture was seen at the same level on the right. The histological examination revealed actinomycosis of the uterus, fallopian tubes, and ovaries. 12 weeks postoperatively the patient was well; sigmoidoscopy to 25 cm showed complete resolution of the rectal stricture. The antibiotic treatment was stopped. The most likely source of this patient's actinomycosis was the IUD for the relationship between the two is well established. In this patient a prolonged course of antibiotics proved effective in treating the infection.
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PMID:Rectal stricture due to actinomycosis. 373 Jul 97

Necrotizing enterocolitis is an uncommon but dangerous disease in premature infants. Ten cases, seen over a three-year period at the Stanford University Medical Center, represented an incidence of 0.4 percent. The patients, six of whom died, derived from a general population, in contrast to the large series of patients reported in the literature in which the incidence was from 0.9 percent to 3.7 percent.(3-6)The initial symptoms-rapid respiration, periodic breathing, lethargy and irritability-were identical to those which occurred in numerous infants who had respiratory disease. Subsequent symptoms (abdominal distension, in 100 percent; vomiting, 80 percent; apneic spells, 70 percent; jaundice, 70 percent; guaic-positive stools, 60 percent) were those of nonspecific acute abdominal disease. The radiologist first made the diagnosis in 90 percent of cases. Interstitial air in the wall of the gut and the retroperitoneum, and portal vein gas were the most diagnostic radiographic features. Barium contrast studies were not helpful, and in one case led to the erroneous diagnosis of small bowel volvulus. Plain abdominal radiographs must be taken of all premature infants with symptoms of nonspecific acute abdominal disease. If the radiographs are negative, but symptoms continue, they should be repeated at frequent intervals, for early diagnosis is critical to institution of proper therapy.
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PMID:Neonatal necrotizing enterocolitis. Clinical and radiological features. 481 93


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