Severe hypertension as an unusual presentation of intussusception in a 6-month-old infant: a case report

Abstract

Intussusception is a common pediatric gastrointestinal emergency that typically presents with abdominal pain, vomiting, and blood-stained stools. Severe hypertension is an uncommon and potentially overlooked manifestation of intussusception. We report a 6-month-old female infant who presented with lethargy, poor feeding, blood-stained stools, and severe hypertension of 130/80 mmHg, exceeding the 95th percentile for age, sex, and length. Serial blood pressure measurements were obtained during quiet, non-distressed periods using an appropriately sized cuff to minimize the possibility of pain- or agitation-related elevation. Initial management included oral nifedipine, followed by intravenous labetalol infusion because of persistent hypertension. Abdominal ultrasonography demonstrated the characteristic target sign of intussusception, which was successfully treated with fluoroscopy-guided pneumatic reduction. Following successful reduction, blood pressure progressively normalized. Evaluation for secondary causes of hypertension, including serum electrolytes, renal function tests, urinalysis, screening echocardiography, and dedicated renal Doppler ultrasonography, revealed no evidence of renal parenchymal disease, renovascular pathology, including renal artery stenosis, or structural cardiovascular abnormalities. Antihypertensive therapy was subsequently tapered and completely discontinued within 5 days after discharge. At 3-month follow-up, the infant remained asymptomatic and normotensive, with no evidence of recurrence. Intussusception may therefore be considered in the differential diagnosis of acute severe hypertension in infants, particularly when gastrointestinal manifestations are present.