Presentation
Previously healthy boy with 2 day history of crampy intermittent abdominal pain occurring every 15 minutes. Decreased appetite and no stools x 2 days was also noted. There was no history of fever or vomiting.
Patient Data
US: In the right lower quadrant, the terminal ileum is noted surrounded by mesenteric structures within the right colon, in keeping with ileocolic intussusception. There is preserved perfusion of the intussusceptum on color doppler assessment. There is an adjacent round well-defined cystic structure measuring up to 3.4 x 2.7 cm containing fluid and hyperechoic material. The wall is well-vascularized on color doppler assessment. The appendix is within normal limits, measuring up to 0.4 cm.
Fluoroscopy: Fluoroscopic air enema study demonstrating air within the small bowel loops in keeping with a successful reduction. There is a rounded density in the region of the ileocecal valve, which can be seen in cases of ileocolic intussusception as the intussusceptum appears as a filling defect in this region. However, given that the presence of air in the small bowel loops suggests that the intussusceptum was reduced, this density is likely in keeping the cystic structure seen on ultrasound.
Case Discussion
While the ileocolic intussusception was successfully treated by air enema reduction, the patient continued to have pain the following day. Ultrasound revealed the persistence of the cystic structure at the level of the ileocecal valve, which was presumed to be a lead point for the intussusception.
Ileocecectomy with primary end-to-end anastomosis was performed and a cystic structure at the level of the cecum was resected. On pathology, this was confirmed to be a cecal duplication cyst.