Surgical treatment of recurrent intussusception induced by intestinal lymphoid hyperplasia in a child: is bowel resection always necessary? A case report

Abstract

Background Intussusception recurrence (IR) induced by intestinal lymphoid hyperplasia (ILH) in children is rare, and surgical treatment is the final resort if IR is refractory to medications and non-surgical interventions. To date, only a few case reports have described surgical management of ILH-induced IR in children, all involving bowel resection regardless of whether there are bowel necrosis and perforation. Case presentation A 2-year-old boy was transferred to our department due to IR. His main complaint was abdominal pain. Color Doppler ultrasound confirmed ileocecal intussusception while no other abnormalities were found. A final diagnosis of IR with unknown causes was made. Repeated saline enema reductions and dexamethasone failed to cure the IR. Laparotomy was eventually performed after almost 10 episodes of IR. Intraoperatively, distal ileum thickening with palpable masses without bowel necrosis and perforation was noted. ILH was suspected and a biopsy of the affected intestine was performed. Histopathological analysis confirmed ILH. The intussusception was manually reduced, the terminal ileum and the ileocecal junction were fixed to the paralleled ascending colon and the posterior peritoneum respectively, and no bowel resection was performed. The postoperative recovery was uneventful and no IR was observed during over 5 years of follow-up. Conclusions As far as we are aware, this is the first report of successful surgical treatment of ILH-induced pediatric IR without bowel resection in a child. Our experience suggests bowel resection may be unnecessary if bowel necrosis and perforation are absent.

Intususcepción intestinal en el contexto de una apendicitis aguda

“…In the present case, the ileocolic location associated with appendiceal invagination is described, leading to acute appendicitis that required surgical resolution. Wang (2010) [10] reported a similar case in a 10-year-old male who presented with intussusception and acute appendicitis secondary to ileocecal Burkitt lymphoma. This finding correlates with that reported by Sheng-Miao (2022) [9], Tomography allows thorough characterization of the lesion, vascular compromise, and related complications, as well as the cause of intussusception (anatomic abnormalities or tumor processes) [12].…”

“…Some studies have described resection of the intestinal segment that caused intussusception and fixation to the retroperitoneum. Nevertheless, no clinical benefit has been found, especially in the absence of necrosis or perforation [10].…”

Liberal surgical laparoscopy reduction for acute intussusception: experience from a tertiary pediatric institute

“…During our pre-protocol period, the majority of patients were successfully managed through pneumatic reduction. However, surgical intervention was essential for approximately one-tenth of all intussusception admissions, due to distinct contraindications for pneumatic reduction or failure of the procedure 14 . Among those who required surgery, 34% needed intestinal resection, even after an initial attempt at air reduction.…”