Quality CareFind out why Mayo Clinic is the right place for your health care. Make an appointment.
Meet the StaffFind a directory of doctors and departments at all Mayo Clinic campuses. Visit now.
Research and Clinical TrialsSee how Mayo Clinic research and clinical trials advance the science of medicine and improve patient care. Explore now.
Visit Our SchoolsEducators at Mayo Clinic train tomorrow's leaders to deliver compassionate, high-value, safe patient care. Choose a degree.
Professional ServicesExplore Mayo Clinic's many resources and see jobs available for medical professionals. Get updates.
Give to Mayo ClinicYou are an essential partner in our work to find answers for our patients. Donate now.
This is a Mayo Clinic Emergency Medicine Residency Interesting Case Presentation using the Pecha Kucha format
Reviewers: Kharmene Sunga, M.D, Fernanda Bellolio, M.D. & Daniel Cabrera, M.D.
Comments by Dr. Mark Mannenbach, M.D.:
This is certainly an interesting case to share.
I have been fooled by the child with altered mental status and vomiting to the point where I have done LP’s with concern for meningitis only to find intussusception as the true diagnosis.
Great to see that you used the “TIPS FROM THE VOWELS” mnemonic for AMS in children. I adopted this earlier in my career after doing unnecessary LP’s.
A few things to consider:
1) Most of our children have had Minnesota newborn screening which is very comprehensive and points away from most of the inborn error issues.
2) Although I don’t do rectal exams on many children, I do recommend that infants with this picture have rectal exams done. 80% of children with intussusception will have Hemoccult positive stools (not grossly bloody or “currant jelly” stools). This might have taken you down the path of intussusception and spared the head CT.
3) I encourage everyone to consider the use of bedside ultrasound to make the diagnosis. Although ultrasound is a great tool, a recent case in the department of a false negative formal ultrasound study has encouraged me to learn more about taking a look myself.
4) I have attached our guideline for management of intussusception to this message. Pediatric surgery rarely needs to be involved unless the child appears ill or if the enema reduction is unsuccessful. If easily reduced, drinking well in the ER, and parents are reliable, many of these children can be sent home. We used this approach during my training and have adopted that approach here.
5) Great to have Tom Hellmich here on staff with us!
Happy to answer any question along the way.
version 188.8.131.52.3.2Page loaded in 0.196 seconds