Altered Mental Status and Intussusception

I recently spent some time with a group of academicians in Raleigh-Durham, NC. Jonathan Singer, MD, a recently clinically retired pediatric emergency medicine physician and faculty at the Wright State Emergency Medicine program, was part of the group. He has impressed me over the years as a tough, no-nonsense academician with a penchant for clinical photography and writing poetry and Broadway plays. The group got into a discussion about pediatric bowel intussusceptions during the meeting, and I was surprised to learn that Dr. Singer wrote one of the first papers describing the altered mental status associated with intussusception. (Pediatrics 1979;64[1]:93; Pediatr Emerg Care 1987;3[2]:118.)   I have always been fascinated by this presentation, but pediatric patients with altered mental status and bowel intussusception have escaped me over the years. Thanks to Dr. Singer and others who have highlighted this, however, I eventually had an opportunity to help one of our own.   Last year just before Christmas one of our nurses and her husband presented to the emergency department with their lethargic 7-month-old daughter. Their concerns were intermittent episodes of pain and that they could not keep her awake. She would briefly rouse, and then her head would immediately flop back down on her chest. I asked the resident working with me to do a rectal examination.   The stool on the glove was dark, soft, and bloody. (Figures 1 and 2.) Our diagnosis was made, and it all took plac...
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