A boy with recurrence intussusception within 48 hours - vague hint not to be missed in primary care

• Main Authors: Shalihin, Mohd Shaiful Ehsan, Mohd Din, Nina Syazmeen
• Format: Proceeding Paper
• Language: English; English; English
• Published: 2023
• Subjects: R Medicine (General); RA Public aspects of medicine; RD Surgery; RJ Pediatrics
• Online Access: http://irep.iium.edu.my/107447/1/Case%20Report_Series_PRD_2023%20Intussesception.pdf; http://irep.iium.edu.my/107447/2/MAKLUMAN%20PENERIMAAN%20ABSTRAK%20BAGI%20PROGRAM%20PAHANG%20RESEARCH%20DAY%202023.pdf; http://irep.iium.edu.my/107447/3/Abstract%20Intussuception.pdf; http://irep.iium.edu.my/107447/

Introduction: Intussusception is the most common abdominal emergency in early childhood, involving invagination of intestinal part into itself. Most cases are idiopathic. Even though a currant-jelly stool is one of the pathognomonic features, it only presents in less than 15% of cases. The clinical diagnosis is often missed in its early presentation as it can mimic other more common non-urgent cases such as viral gastroenteritis. Recurrence case within 48 hours of reduction intervention is even rare and can be falsely suspected as normal presentation in the post procedure sequalae. We highlighted a recurrence case in a 4-year-old boy who was initially well after discharge to home and caused an initial dilemma in the diagnosis. Case description: A 4-year-old boy presents with isolated mild lower abdominal pain for six hours. Each episode lasts for less than a minute and is resolved on its own. Otherwise, the child is ambulating well, tolerating orally and able to pass bowel and flatus as usual. He was discharged surgically about 48 hours prior to the onset of current new presentation for intussusception reduction. Medical attention was sought initially but was informed that it could be a usual post-operative symptom which should be resolved in a few days. Nevertheless, his mother seeks second opinion from us in primary care in view of its persistent frequency pattern. Without delay, we advise for readmission of the child for suspected intussusception recurrence despite no other concomitant symptoms and signs. This child benefited from our high clinical suspicion and is referred back to the surgical team for subsequent successful surgical reduction. Learning Point/Conclusion: Regardless of the mild severity of gastrointestinal symptoms, the possibility of intussusception recurrence should be suspected despite presumed success of the initial intervention. Each caregiver should be given safety netting to bring back the child to the treating team in any case of suspicious.