Ileocolic intussusception associated with a multicentric round cell tumor in a red-tailed boa constrictor (Boa constrictor constrictor)

A 5-year-old, female red-tailed boa constrictor ( Boa constrictor constrictor ) was presented with hyporexia, regurgitation and progressive focal distention of the caudal coelom since two months. During physical examination a firm, well-demarcated and movable intracoelomic mass was detected halfway down the caudal coelom but no other abnormalities were noticed. Ultrasonographic examination showed the mass to consist of an intestinal intussusception. A complete blood cell count and serum biochemistry blood test results revealed mild anemia and leukocytosis as well as hyperuricemia and hyperphosphatemia with inversion of the calcium/phospohorus ratio. Explorative coeliotomy was performed and revealed anterograde invagination of the ileum into the colon through the ileocolic junction. Although the intussusception was surgically repositioned, the snake died three weeks post-operatively despite showing a good general condition and defecation following assisted feeding. During necropsy, a thickened wall of the caudal segment of the ileum that was previously involved in the intussusception was observed as well as the presence of multifocal, white nodules throughout the parenchyma of the liver, spleen and kidneys. Histopathological examination demonstrated a malignant round cell tumor of the ileum with infiltration of neoplastic round cells in the liver, spleen and kidneys. Immunohistochemical staining (CD3, CD20, MAC387, S100 and NSE) could not confirm the cell origin of the round cell tumor. The present case highlights the need to include round cell tumors as a differential diagnosis in the development of ileocolic intussusception in red-tailed boa constrictors.

An Infant with COVID-19-Associated Intussusception

Intussusception is the most common cause of bowel obstruction in infants four to ten months old and is commonly idiopathic or attributed to lymphoid hyperplasia. Our patient was a 7-month-old male who presented with two weeks of intermittent abdominal pain associated with crying, fist clenching and grimacing. Ultrasound demonstrated an ileocolic intussusception in the right abdomen. Symptoms resolved after contrast enemas, and he was discharged home. He re-presented similarly the next day and was found to be COVID-19 positive. Computed tomography scan demonstrated a left upper quadrant ileal-ileal intussusception. His symptoms spontaneously resolved, and he was discharged home. This suggests that COVID-19 may be a cause of intussusception in infants, and infants presenting with intussusception should be screened for this virus. Additionally, recurrence may happen days later at different intestinal locations. Caregiver education upon discharge is key to monitor for recurrence and need to return.

Reduction of ileocolic intussusception under sedation or anaesthesia: a systematic review of complications

BackgroundDespite the increased use of sedation in children undergoing stressful procedures, reduction of ileocolic intussusception (RII) is usually performed on awake children without any form of sedation.ObjectiveTo evaluate the incidence of severe complications of RII under sedation or anaesthesia.DesignA systematic review including English language original articles of any date.PatientsChildren undergoing RII (pneumatic or hydrostatic) under sedation or anaesthesia.Data sourcesOvid Embase, Scopus, PubMed, the Cochrane Database of Systematic Reviews and the internet search engine Google Scholar.Data extractionThree authors independently reviewed each article for eligibility. The Newcastle-Ottawa Scale was used to assess the quality of included studies.Main outcome measuresThe primary outcome was the incidence of intestinal perforation during RII. The secondary outcomes were the incidence of sentinel adverse events defined as death, cardiopulmonary resuscitation, permanent neurological deficit and pulmonary aspiration syndrome.ResultsThe search yielded 368 articles. Nine studies with 1391 cases were included in the analysis. Of the nine studies, six had a score of ≤6 stars in the Newcastle-Ottawa Scale assessment, indicating low-to-moderate quality. Propofol-based sedation was used in 849 (59.2%) cases; 5 (0.6%) had intestinal perforation. Intestinal perforation was not reported in patients who were sedated with other sedatives. One patient had pulmonary aspiration syndrome.ConclusionsAlthough caution remains warranted, current data suggest that the incidence of severe complications due to RII under sedation or anaesthesia is low. Due to the lack of prospective data, it is difficult to ascertain the exact incidence of severe complications.

Management of ileocolic intussusception in the Czech Republic

Introduction: Ileocolic intussusception is one of the most frequent causes of acute abdomen in infants and toddlers. The purpose of this study was to evaluate the treatment of ileocolic intussusception in the Czech Republic in 2019. Methods: Fourteen departments of paediatric surgery participated in this multicentre retrospective study. A SurveyMonkey Inc. questionnaire was used for anonymous data collection of patients with ileocolic intussusception. Results: In 2019, ileocolic intussusception was diagnosed in 162 patients; median age was 30 months (3 months to 9.5 years). Contrast enema was indicated in 133 patients, primary surgery in 14 patients and spontaneous reduction was found in 15 patients. All departments using contrast enema had a success rate of 89.5%; 12 departments approached the contrast enema procedure under general anaesthesia (including myorelaxation at 7 departments) and 2 departments under sedation. Contrast enema under general anaesthesia with/without myorelaxation was significantly more successful than contrast enema under sedation (108/113, 95.6% vs 11/20, 55%; p<0.0001). In total, 28 patients were treated surgically, in 14 primary surgery was performed. Both surgical treatment and bowel resection were statistically significantly more frequent in departments where contrast enema was performed under sedation in comparison to departments performing contrast enema under general anaesthesia (9/20, 45% vs 19/142, 13.4%; p=0.0018 and 7/9, 77.8% vs 5/19, 26.3% p=0.0166). Conclusion: The success rate of contrast enema in the Czech Republic was 89.5%. The highest success rate is achieved by performing contrast enema under general anaesthesia.

Burkitt’s Lymphoma of Intestine Presenting as Ileocolic Intussusception

Burkitt lymphoma, as the most common non-Hodgkin Bcell lymphoma of childhood, is rarely detected in the gastrointestinal tract. Intussusception secondary to Burkitt’s lymphoma is an uncommon presentation. We describe an unusual case of intestinal Burkitt’s lymphoma in a four and the half-year-old girl who presented with intermittent colicky pain three times. Imaging studies were suggestive of intussusception. The patient was subjected to the surgery of bowel resection, which revealed a creamy-gray oval-shaped mass. Histopathology through immunohistochemistry study confirmed the Burkitt lymphoma. Owing to rather nonspecific clinical and radiological features, the preoperative diagnosis of Burkitt lymphoma remains a challenging task for pediatric surgeons and radiologists. Therefore, in case of any clinical suspicion, further examinations, such as CT scan in children are recommended.