Medical Treatment of Recurrent Intussusception Associated With Intestinal Lymphoid Hyperplasia

Abstract

Intestinal lymphoid hyperplasia (ILH) is an uncommon cause of recurrent intussusception in infants and young children. Surgical treatment has been suggested in the management of this disorder. We report 2 cases in which recurrent intussusception was associated with ILH. A short course of steroids resulted in resolution of both symptoms and hyperplasia. We conclude that when recurrent intussusception occurs in association with ILH, and no other lead point can be identified, it is important that treatment with steroids is considered before resorting to a more radical surgical approach.

The role of steroids in children with multiple recurrences of intussusception

“…Non‐specific in nature, it may be caused by viral or parasitic infections. Evidence for either was not found in this patient, although exhaustive viral serology was not performed due to the finding of panhypogammaglobulinaemia 1,3 . Intestinal lymphoid hyperplasia has also been reported in association with immunodeficiency.…”

“…Lymphoid hyperplasia in the terminal ileum is a recognised cause of intussusception 1,3 . Non‐specific in nature, it may be caused by viral or parasitic infections.…”

Successful dietary treatment of recurrent intussusception

“…Two previous cases have been reported where recurrent intussusception associated with intestinal lymphoid hyperplasia was treated with oral steroids resulting in resolution of the lymphoid hyperplasia and cessation of the recurrent intussusceptions 1. However this is the first case to be successfully treated with a hypoallergenic diet.…”

Chronic intussusception in children caused by Ascaris lumbricoides

“…Recurrent abdominal pain, palpable abdominal mass, vomiting, rectal bleeding, diarrhea, loss of appetite, nausea, weight loss and microcytic anemia are most common signs of CI [3,5]. Sometimes it is related to non-Hodgkin lymphoma, Yersinia enterocolitica mesenteric adenitis, Ewing sarcoma, intestinal lymphoid hyperplasia or parasitic infection [1,[6][7][8][9]. Th e incidence is estimated to be about 5% of all intussusceptions, fewer in young children than in preschool age [1,5,6].…”

“…Th erapy is surgical with obligatory exclusion of possible underlying lesions, especially in older children [8,10].…”