A Case of Intussusception with Acute Appendicitis

Abstract

In children presenting to hospital with gastrointestinal symptoms, diseases such as intussusception and acute appendicitis require particular attention and careful examination. Early diagnosis and proper treatment are important because of possible severe complications such as peritonitis and death. Intussusception and appendicitis share similar clinical manifestations. More importantly, the presence of acute appendicitis together with intussusception in children is very rare. We describe an interesting case of a 38-month-old boy who presented with abdominal pain in the right lower quadrant. His vital signs were stable and laboratory test findings showed no specific alterations. We detected tenderness in the right lower quadrant. A computed tomography scan showed an ileocolic intussusception with no strangulation and diffuse wall thickening of the appendix trapped within the intussusception. The patient underwent an appendectomy and manual reduction.

Characteristics of intussusception among children in Korea: a nationwide epidemiological study

“…In most cases, intussusception is known to be idiopathic without any underlying disease [7]. However, idiopathic intussusception can also occur after respiratory or gastrointestinal infections, and is associated with various diseases such as Henoch-Schönlein purpura (HSP), lymphoma, Meckel’s diverticulitis, and polyps [7–9]. Although it is not known to be related to natural rotavirus infections, there have been previous reports of intussusception following rotavirus vaccines.…”

Concurrent acute appendicitis and ileocolic intussusception in a 1-year-old child

“…Most commonly, patients present symptoms of intussusception between 3 months and 5 years of age, with 80%-90% of the cases occurring in patients younger than 2 years [2] . A lead point is rarely diagnosed in children younger than 4 years (2%-12%) and therefore is not generally a focus of investigation when intussusception is suspected in this age group [3] . When intussusception does occur, it is most commonly due to Meckel's diverticulum [4] .…”

“…Appendiceal intussusception is particularly rare with an incidence of 0.01% according to a pathologic review of 71,000 human appendix specimens [5] . In medical literature, this condition has rarely been described in only a handful of case reports, one of which was from 1957 [6] , [7] .…”

Successful treatment of intussusception by hydrostatic reduction in pediatric patients: Is everything okay?

“…The main challenge for pediatric surgeons in intussusception is the diagnosis and treatment of invaginations caused by pathological leading points [1,2,5,10]. In those patients, USG has a 75% sensitivity and specificity rate whereas CT has 50% [2].…”

“…As the incidence rate of intussusception with a secondary condition is around 6%, surgical treatment is indicated in most of those cases [2,4]. In those cases, severe or even fatal complications such as bowel perforations or peritonitis can be seen due to the difficulties in the treatment of the conditions [2,5]. In intussusception diagnosis, ultrasonography (USG) has an almost 100% sensitivity and specificity.…”