Case Report: An unusual case of wide ileoileal intussusception associated with intestinal volvulus in a 8-months-old infant

TL;DR

This case report describes a rare connection between intestinal volvulus and intussusception in an 8-month-old infant.

Contribution

This is the first reported case linking intestinal volvulus with a massive intussusception in a pediatric patient.

Findings

An 8-month-old infant presented with a rare combination of intestinal volvulus and ileoileal intussusception.

Surgical findings included a dilated, ischemic intestinal loop and an extensive occluding ileoileal invagination.

The reported case adds to the limited literature on the potential clinical connection between volvulus and intussusception.

Abstract

Midgut volvulus and intussusception are prevalent paediatric abdominal emergencies. To the best of our knowledge, this is the first reported case of a connection between intestinal volvulus and a massive intussusception.

An 8-month-old male infant was brought to the emergency room with a history of abdominal pain and vomiting for <24 h. On physical examination, the child appeared restless and was found to have a circumferential hard mass of approximately 4 cm in diameter in the epigastric region. Upon admission, laboratory results showed a C-reactive protein level of 0.4 mg/dl, LDH level of 351 U/L, mild leukocytosis with a white blood cell count of 12 × 103 /µl, and 67% neutrophils. A physical exam was significant for abdominal distention, hyperresonance in percussion, and a palpable, painful epigastric mass. The findings of the operation included a dilated and ischemic intestinal loop, approximately 25 cm from the ileocecal valve, twisted upon itself for three turns. After de-rotation, an extensive occluding ileo-ileal invagination with an ischemic intestinal loop was identified, and a length of approximately 55–60 cm of the distal ileum, including the ischemic segment, was resected.

This is the first reported case of a connection between intestinal volvulus and a massive intussusception. Currently, only two reported cases describe the connection between volvulus and intussusception, which are insufficient to establish a direct link between the two clinical conditions.

Figures