jiafm, 2010-32(2) april-june. - forensic medicine

J Indian Acad Forensic Med, 32(2) ISSN 0971-0973The classical clinical manifestations ofintussusception are colicky abdominal pain, reflexvomiting, currant-jelly stool and palpable abdominalmass. But it is not always true that all patients maypresent with classical manifestations. In studyconducted by Stringer et al, between 13 to 20% ofchildren with intussusception have no signs ofabdominal colic or discomfort and such presentingintussusception is called as “painlessintussusception”. Moreover, small bowelintussusception does not tend to produce the classicsymptoms and signs. Similarly, only half of thechildren with ileocolic intussusception had a historyof abdominal colic and in only one fifth was there apalpable abdominal mass. [2] Therefore such casespose difficulty for doctor to diagnose the conditionand treat accordingly.It has been shown that unexpected death ismore likely to occur in older children with purelysmall intestinal intussusception. [5] However, theforegoing case exhibits mortal potential andunexpected death can occur at any age withintussusception at any level. Moreover, ifintussusception is painless one and that too occurringat multiple sites then risk increases manifold.Considering the autopsy practice, it is to beemphasized that autopsy of infant need specialattention especially when history is lacking orinappropriate. Painless intussusceptions are deceitfulin their presentations. [3]The Forensic Pathologist should be aware of suchcondition. The autopsy assessment of death due tointussusception requires careful systemic or localevaluation for presence of any lesion that had causedthe intussusception. [5]In conclusion it can be added that improvements inthe management of childhood intussusceptions arelikely to be grow from a wider appreciation andunderstanding of diverse possible presentations of thecondition and helps to reduce morbidity andmortality.Figure No. 1Photograph showing ileo-ileal intussusceptionReferences:1. Stein M, Buchta R, Raszynski A, Nyhan W L.Intussusception. West J Med 1979; 130: 35-42.2. Stringer MD, Pledger G, Drake DP. Childhooddeaths from intussusception in England and Wales,1984-9. BMJ 1992; 304: 737-9.3. Ng‟walali PM, Yonemitsu K, Tsunenari S. Fatalintussusception in infancy: an experience in forensicautopsy. Leg Med 2003; 5: 181-4.4. Macdonald IAR, Beattie TF. Intussusceptionpresenting to a paediatric accident and emergencydepartment. J Accident and Emergency Medicine 1995;12: 182-6.5. Byard RW, Simpson A. Sudden death andintussusception in infancy and childhood – autopsyconsiderations. Med Sci Law 2001; 41: 41-5.173