Presentation
Diarrhea for two weeks, presented to the casualty with right iliac fossa pain for 2 days. Initial ultrasound showed intussusception, but the appendix couldn't be identified separately from the mass.
Patient Data
A telescoping bowel mass noted at the right iliac fossa, formed as ileo-cecal intussusception, measures about 40 x 32 x 30 mm with thick edematous walls. Oral contrast is passing freely to the colon. No evidence of pneumoperitoneum, peri-colic collections, or contrast leakage.
Appendix of normal caliber, harbors air inside with no signs of acute inflammation, separated from the mass except its base.
Multiple mesenteric lymph nodes ranging from 5 to 7 mm (short axes).
Umbilical hernia contains omental fat.
Diagnosis was made as ileo-cecal intussusception.
Operative notes:
Incision:
RIF-Lanz incision
Separate infraumbilical curvilinear incision
Findings:
Ileo-caeco-colic intussusception manually reducible with viable bowel, congested appendix, and moderate reactionary fluid.
Procedure:
Intussusception was delivered out, manually milked to complete reduction
Very big LNs, so biopsy was taken from one of them
Appendectomy was done after securing mesoappendix
Cecopexy hitching was done with parietal abdominal wall
Umbilicus was opened inferiorly
Neck of the defect was isolated
Closure with interrupted sutures
Neo-umbilicus was created
Postoperative diagnosis:
Ileo-caeco-colic intussusception with umbilical hernia
Case Discussion
Intussusception may occur almost anywhere. In adults, there is no pattern of distribution since, in the great majority of instances, a lead point lesion exists, and so the location is determined by the location of that lesion.
In children, the ileocolic region is frequently involved:
Ileo-colic is the most prevalent (75–95%), mostly due to the amount of lymphoid tissue in the terminal ileum and the structure of the ileo-cecal region.
Ileo-ileo-colic is the second most frequent.
Ileo-ileal and colo-colic are rare.
Gastric intussusception is uncommon but recorded.
I would like to express my gratitude to Dr. Debashish Chittaranjan Bhattachariya, Dr. Abdullah Amer Al-Hamar and Dr. Aftab Hussain Hussain, SQH Pediatrics Surgery Department, for their informative operative notes.
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