Neonatal intussusception: A rare but important condition to diagnose

Abstract

Intussusception is one of the most common causes of intestinal obstruction in infancy but rarely occurs in the neonatal period. The presentation, pathology and management of neonatal intussusception are quite different from the usual childhood intussusception. Over a 2-year period, we have managed three cases. We herein report our experience to highlight the diversity in presentation and management of neonatal intussusception. Case reports Patient 1A 695-g boy was born prematurely at 26 weeks of gestation due to placenta abruptio. He developed respiratory distress syndrome and required mechanical ventilation at birth. He was noted to have persistent abdominal distension, and was initially managed as necrotizing enterocolitis. He developed pneumoperitoneum on day 6 and hence emergent laparotomy was carried out. Intraoperatively, an ileo-ileal intussusception with proximal bowel perforation was found at the terminal ileum. Approximately 3 cm of the terminal ileum bearing the intussuscepted mass and 2-cm proximal ischaemic bowel were resected and a double barrel ileostomy was fashioned (Fig. 1). There was no pathological lead point identified on specimen examination. Feeding was resumed on postoperative day 15 and full feeding was achieved on day 41. The ileostomy was closed at 99 days old. He was well on follow up at 16 months. Patient 2A 3800-g full-term boy with antenatally diagnosed dilated bowel loops was found to have abdominal distension after birth. An abdominal X-ray film showed loops of dilated bowel suggestive of small bowel atresia. Exploratory laparotomy confirmed type 1 ileal atresia secondary to in-utero intussusception from an inverted Meckel's diverticulum (Fig. 2). The atretic segment together with the 8-cm dilated and hypertophic proximal bowel were resected and primary anastomosis was carried out. The postoperative course was uneventful. Feeding was started on day 11 and full feeding was achieved on day 17. He was well on follow up at 3 months old. Patient 3A 3150-g boy was born uneventfully via vaginal delivery at full term. Physical examination at birth was unremarkable. He did not have any bowel motion since the passage of meconium on the first day and developed bilious vomiting and abdominal distension on the second day after birth. Abdominal X-ray showed dilated bowel loops. Water-soluble contrast enema showed a microcolon and a small-calibre terminal ileum suggestive of small bowel atresia. Emergent laparotomy confirmed type 1 ileal atresia secondary to an intussuscepted inverted Meckel's diverticulum and a perforation over the distal end of the dilated proximal bowel. The abnormal bowel was resected and primary anastomosis was fashioned. The recovery was uneventful with feeding started on day 12 and full feeding achieved on day 22. He was well on follow up at 74 days old. DiscussionIntussusception is common in children aged 3-18 months. These infants classically present with sudden onset of colicky abdominal pain, vomiting and, later, per rectal bleeding. With experience, the diagnosis can...