Treatment Strategies for Recurrent Ileocolic Intussusceptions and a Novel Operative Procedure

Background Intussusception is the most common cause of intestinal obstruction between 6 months and 36 months of age. There is no defined etiology in at least 75-90% of patients. Recurrent intussusception occurs in 5-16% of all intussusceptions and the treatment strategy is controversial in this patient group. Treatment of continued recurrent intussusception is a challenging problem when no lead point is revealed despite recurrence. We aimed to review our 10 years of experience in recurrent intussusception and describe a new operative technique for recurrent intussusception cases without any lead points. Results We retrospectively reviewed the data of patients with recurrent intussusception in our referral pediatric surgery clinic between 2007 and 2017. Ultrasound-guided hydrostatic reduction was performed on all patients. Surgery was performed on those patients who had findings of acute abdomen and complete intestinal obstruction or 2 failed attempts of UGHR for diagnostic purposes if a pathologic lead point was suspected based on patient findings and age. Laparoscopy or laparotomy was performed according to surgeon preference and experience. A total of 87 UGHRs were performed. Thirty-three patients were admitted to our clinic due to recurrent intussusception. The mean age was 12.75±14.14 (6 -84) months, and 19 were males and 14 were females. Abdominal pain, agitation and vomiting were common symptoms. UGHR was performed on all 33 patients on at least 2 different occasions. The time between the first and second UGHR treatments was 42.6 ± 186.19 (0-899) days. The success rate of the second UGHR was 27 out of 33 patients (81.8%). Surgery was performed on 6 patients. Manual reduction was performed on 5 patients and one was operated by the laparoscopic reduction of intussusception and Meckel’s diverticulum resection. Conclusions Surgeons should try to find permanent solutions for patients with multiple recurrent intussusceptions that are resistant to treatment. Surgical excision of the lead point will help prevent recurrent intussusception. Satisfactory results can also be obtained by ultrasound-guided hydrostatic reduction even in patients with recurrences. Laparoscopy is helpful in diagnosis, detection of lead points and treatment of irreducible intussusception. This new operative technique can be satisfactory for recurrent intussusceptions without any lead points.

Recurrent intussusception as a rare clinical manifestation of intestinal malrotation in children—a case report and review of literature

Background Mobile caecum along with malfixed small bowel mesentery in malrotation is incriminated to cause intussusception in children. This dual association is very rare and is labeled as Waugh’s syndrome. This is often missed during conservative management of intussusception and may manifest as chronic intussusception. Case presentation We report a rare case of intestinal malrotation in a 13-year-old boy who presented as recurrent intussusception. The child was resuscitated and was operated, where malrotation of gut was detected. We discuss the clinical presentation, radiological findings, and management of this rare association in light of current available literature. Conclusion The presence of mobile caecum and redundant bowel loops with narrow mesentery in case of malrotation is an important factor leading to intussusception.

MIRAGE Syndrome Caused by a De Novo c.3406G>C (p. Glu1136Gln) Mutation in the SAMD9 Gene Presenting With Neonatal Adrenal Insufficiency and Recurrent Intussusception: A Case Report

IntroductionPrimary adrenal insufficiency (PAI) presenting in the neonatal period can be life threatening and requires early recognition, diagnosis, and management. PAI due to adrenal hypoplasia (syndromic/non-syndromic) is a rare disorder. MIRAGE is a recently described syndrome with PAI and multisystem involvement.Case PresentationA preterm female neonate presenting with PAI and persistent severe thrombocytopenia was diagnosed to have MIRAGE syndrome due to a de novo pathogenic variant c.3406G>C (p. Glu1136Gln) in the SAMD9 gene. In the first year of life, she had recurrent respiratory and gastrointestinal infection causing failure to thrive. At 17 months, she suffered recurrent intussusception requiring treatment with parenteral nutrition and high-dose steroids. Subsequently, she established oral feeds with hydrolysed formula and demonstrated good weight gain.ConclusionIn neonates presenting with PAI and associated multisystem involvement, a thoughtful approach and genetic testing is valuable in discerning an etiological diagnosis. This case of MIRAGE adds to the spectrum of reported cases and is the first to report on recurrent intussusception and its management with high-dose steroids.

Intermittent intestinal intussusception in patients with mesenteric lymphadenitis in the ileocecal angle

Introduction. At present, lymphadenopathy – as a cause of idiopathic intestinal intussusception in little children - comes to the fore. However, intestinal intussusception in case of destructive mesenteric lymphadenitis in combination with lymphoid hyperplasia of the ileocecal angle ( what does not exclude lymphoma intraoperatively) is extremely rare in clinical practice.Purpose. To present a therapeutic and diagnostic algorithm in intestinal intussusception which was caused by the “volumetric“ abdominal lymphadenopathy.Case Report. A 3-year-old boy was admitted by the ambulance with recurrent abdominal pain, single episode of vomiting and no stool for 4 days. The ultrasound examination revealed intermittent ileocecal intussusception. The risk factor which had triggered the disease was an acute respiratory viral infection complicated with purulent mesenteric lymphadenitis and lymphoid hyperplasia with ulcerative lesions of the mucous membrane in the ileocecal junction. Laparoscopic desinvagination with lymph node removal and colonoscopy with ladder biopsy were performed. A differential diagnostics of nonspecific lymphadenopathy, Burkitt’s lymphoma and Crohn’s disease was made. Immunohistological examination intraoperatively was made; examination of the biopsy material excluded tumor and inflammatory bowel disease (IBD). The inflammatory process regressed under conservative therapy (antibacterial, anti-inflammatory and antispasmolytic) ; there were no any recurrent intussusception episodes within one-year follow-up.Conclusion. Successive ultrasound, laparoscopic and colonoscopic examinations followed by the immunohistological analysis of intraoperative and biopsy material allowed to put a correct diagnosis and, thereby, to minimize surgical aggression in ileocecal intussusception which was accompanied by volumetric lymphadenopathy.

Running for the Runs: Intermittent Intussusception From Vanek Tumor Manifesting as Constipation Improved With Exercise

ABSTRACT Constipation commonly affects adults and most often results from benign conditions. Certain associated symptoms (e.g., rectal bleeding or weight loss) raise concern for structural pathology and prompt further evaluation. Intussusception uncommonly affects adults and typically presents with abdominal pain and vomiting. Rarely, intussusception manifests with constipation as the primary symptom. We present a case of a patient with new onset constipation who was only able to induce bowel movements after exercising, a compensatory behavior in the setting of recurrent intussusception because of a Vanek tumor.

SURGICAL INDICATION IN TRANSIENT OR RECURRENT INTUSSUSCEPTION IN PAEDIATRIC PATIENTS – A DILEMMA FOR MANAGEMENT

Background – Intussusception is one of the most common abdominal emergencies dealt in early childhood by Paediatric Surgeons. We paediatric surgeon dealt various abdominal emergency in early childhood, Intussusception is the one of them. The decision to operate on patients of intussusception may sometimes be difcult, such as when the patients have transient intussusception without features of intestinal obstruction, like abdominal distension. Decision for surgery in patients of intussusception is very difcult in some circumstances like patient have complaint of abdominal pain only or transient intussusception. No other sign and symptoms of intestinal obstruction, abdominal distention. So, we did this study in such circumstances. to study the patients of recurrent intussusception, trans Aims and objectives - ient intussusception or newly diagnosed intussusception without intestinal obstruction, who had abdominal pain either off and on or continuous for long time. this is a Methods – retrospective study. It was conducted between January 2020 to December 2020 at Department of Paediatric surgery, Sir Padampat Mother and Child health institute, S.M.S. Medical College, Jaipur. Patient of persiste Conclusion - nt abdominal pain due to recurrent transient intussusception with or without classical triad is the matter of surgical intervention in paediatric patients.

Inflammatory myofibroblastic tumor of caecum presenting as recurrent intussusception: A case report

Background: Inflammatory myofibroblastic tumor is an uncommon tumor. It commonly affects the lung but it can be found anywhere in the body. Case Report: We are reporting a case of caecal mass presenting as recurrent intussusceptions. Histopathology and immunohistochemistry confirmed it to be an inflammatory myofibroblastic tumor of caecum. Immunohistochemistry of tumor cells were positive for vimentin, smooth muscle actin, MIB 1, and CD 45 in lymphoid cells in the stroma of the tumor. Conclusion: Recurrent intussusception should be kept as one of the differential diagnosis in patient with caecal mass with recurrent abdominal pain. Inflammatory myofibroblastic tumor of the caecum is unusual in paediatric patients and may present as recurrent intussusception.

Single-site laparoscopic treatment of pathological intussusception secondary to heterotopic pancreas in an 11-month old infant

Background: Intussusception in children is mostly idiopathic, while intestinal intussusception in infancy is uncommon. Specially, intussusception caused by isolated ileal heterotopic pancreas, the abnormal localization of a well-differentiated pancreatic tissue in the ileal serosa, is relatively rare. Early recurrence of intussusception would suggest the presence of pathological lead point and the possibility of surgical exploration. Case presentation: An 11-month-old boy, diagnosed with recurrent intussusception caused by ileal heterotopic pancreas, was admitted to our hospital. After admission, the baby was resuscitated with normal saline and received air edema twice, but both failed. Given the presence of pathological intussusception, the boy was sent to operating theater and received a single-site laparoscopically assisted surgery. The patient recovered successfully and got a satisfactory cosmetic result.Conclusions: Due to its minimally invasive and diagnostic advantages, laparoscopy proves to be a safe and attractive alternative, especially for emergency patient with stable hemodynamics but no definite radiological diagnosis. Meanwhile, we emphasize the importance of paying essential attention to the condition that recurrent intussusception of extreme age should always be taken into consideration.