Recalcitrant intussusception: exploring potential associations with Helicobacter pylori infection - a case report and literature review

TL;DR

A case report suggests that Helicobacter pylori infection may be linked to recurrent intussusception in children, especially when combined with Henoch-Schönlein purpura.

Contribution

This case report is the first to suggest a potential role of Helicobacter pylori in causing recalcitrant intussusception.

Findings

A two-year-old girl with recurrent intussusception showed resolution after treatment for Helicobacter pylori.

Helicobacter pylori infection may trigger Henoch-Schönlein purpura, which could lead to intussusception.

The case highlights the need to consider H. pylori in children with steroid-resistant Henoch-Schönlein purpura and intussusception.

Abstract

Intussusception, a common cause of abdominal pain in children, often lacks clear underlying causes and is mostly idiopathic. Recurrence, though rare, raises clinical concerns, with rates escalating after each episode. Factors like pathological lead points and Henoch-Schönlein purpura (HSP) are associated with recurrent cases. On the other hand, the prevalence of Helicobacter pylori (H. pylori), often asymptomatic, in children has been declining. Although its infection is reported to be linked with HSP, its role in recurrent intussusception remains unexplored. Further research is needed to understand the interplay among H. pylori (culprit pathogen), HSP (trigger), and intractable intussusception so as to develop effective management strategies.

A two-year-old girl experienced four atypical episodes of intussusception at distinct locations, which later coincided with HSP. Despite treatment with steroids, recurrent intussusception persisted, suggesting that HSP itself was not a major cause for intractable presentations. Subsequent identification of H. pylori infection and treatment with triple therapy resulted in complete resolution of her recalcitrant intussusception.

This instructive case underscored a sequence wherein H. pylori infection triggered HSP, subsequently resulting in recurrent intussusception. While H. pylori infection is not common in young children, the coexistence of intractable intussusception and steroid-resistant recurrent HSP necessitates consideration of H. pylori infection as a potential underlying pathogen.

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