# Recurrent Ileocolic Intussusception With the Appendix as the Pathologic Lead Point in Children: A Report of Two Cases and Review of Literature

## TL;DR

This paper reports two rare cases of recurrent ileocolic intussusception in children where the appendix was the cause and highlights the need for surgical intervention.

## Contribution

The paper adds to the rare documentation of the appendix as a pathologic lead point in recurrent ileocolic intussusception in children.

## Key findings

- The appendix was identified as the pathologic lead point in two cases of recurrent ileocolic intussusception.
- Surgical reduction and appendectomy were required after failed pneumatic reduction in both cases.
- Literature review suggests surgical intervention is preferred when a pathological lead point is suspected.

## Abstract

Ileocolic intussusception is a consideration in young pediatric patients with acute abdominal pain. Meckel’s diverticulum is the most common pathologic lead point for intussusception in children and the appendix acting as the lead point is rare. In addition, management guidelines for recurrent ileocolic intussusception (RICI) are lacking. We present two cases of RICI in which the pathological lead point was the appendix.

The first patient, a two-year-old with no medical history, had intermittent abdominal pain and non-bloody vomiting for a month. Ultrasound revealed ileocolic intussusception, successfully managed with pneumatic reduction. However, symptoms recurred and a repeat ultrasound showed partial intussusception of the appendix into the cecum. Laparoscopic reduction and appendectomy were then performed. Symptomatic intussusception recurred, and a second laparoscopic reduction with stump appendectomy resolved all symptoms. The second patient, a three-year-old with no medical history, had colicky abdominal pain for 24 hours. Ultrasound revealed ileocolic intussusception that was pneumatically reduced. As pain recurred, laparoscopic reduction and appendectomy were performed, revealing ileocolic intussusception with a dilated appendix as the pathologic lead point.

Recurrent ileocolic intussusception (RICI) with the appendix as the lead point is common, but RICI with the appendix as the lead point is rare. These cases demonstrate the role of the appendix as a pathologic lead point, and a review of the literature supports the need for surgical reduction. While enema reduction is the first line for recurrent intussusception, surgical reduction is preferred when a pathological lead point is suspected.