Intussusception Associated with Necrotizing Enterocolitis

Abstract

Two premature infants whose clinical picture initially was that of necrotizing enterocolitis eventually developed intussusception. The symptomatology of these two conditions is similar, and when they coexist, recognition of a complicating intussusception is difficult. The pathogenic relationship between necrotizing enterocolitis and intussusception remains obscure. The possibility that necrotizing enterocolitis can be a leading point in the development of intussusception is discussed.

Intussusception in preterm infants: case report and literature review

“…Whilst in full-term neonates intussusception may be caused by an underlying lesion acting as a pathological pinpoint [9,19], in preterm infants no anatomical abnormalities were found on surgery. In four patients, however, simultaneous conditions such as a meconium plug in the terminal ileum [4], a preceding abdominal surgical intervention [1] and concomitant NEC [13] were described. The association of bowel atresia and intussusception is well-known in full-term neonates.…”

“…Histological studies suggest that intussusception may occur ®rst, presumably prenatally, leading to vascular impairment with subsequent bowel necrosis resulting in secondary congenital intestinal atresia [5,17]. In 4 of the 17 reviewed preterm infants [7,13,15,17], a concomitant atretic segment was found at the time of delayed surgery. Clinical signs of intussusception appeared to be nonspeci®c in the reported patients.…”

Intussusception in an extremely premature infant following bacterial sepsis

“…Indeed, several reports have described cases of intussusception coexisting with necrotizing enterocolitis, in which gangrene or stricture formation following intestinal ischemia was suspected as a possible cause of bowel telescoping [3,4,8,12,13]. However, as in the present case, the exact etiopathology of intussusception without a recognizable leading point remained unclear.…”

“…Onset of symptoms in premature infants with intussusception usually occurs at around 10 days old, when hypoxic and ischemic events due to delayed cardiopulmonary adaptation are most likely to occur [7,10,12]. Symptom onset at 35 days old in this case represents one of the most delayed examples, suggesting that intestinal hypoxia and ischemia from any cause could represent a triggering factor for the pathogenesis of this rare clinical entity.…”

Clinical features and treatment outcome of intussusception in premature neonates

“…Similarly, patients with NEC are at increased risk of stricture formation. Three patients with IPN were diagnosed with NEC, 8,25 of which, 2 had strictures. Thus, enteric vascular ischemia may be the common underlying cause of both IPN and NEC in premature neonates.…”