Intussusceptions arising from two different sites in a child with cystic fibrosis

Colocolic Intussusception in Children: A Case Series and Review of the Literature

Background

Colocolic intussusception is a rare subtype of intussusception mostly caused by juvenile polyps. The treatment of colocolic intussusception caused by other pathologic lead points in children remains poorly understood.

Method

A systematic literature review was performed between January 2000 and June 2021 to characterize the comprehensive treatment of colocolic intussusception in children. This report also included patients admitted to our center between January 2010 and June 2021 who were not previously reported in the literature.

Results

We identified 27 patients in 20 studies in addition to 17 patients from our center for a total of 44 patients (median age, 4.4 years; 52.3% male). The lead point was identified in 40 patients (40/44, 90.9%). The most common lead point was juvenile polyps (19/44, 43.2%). A therapeutic enema was performed in 15 patients with colocolic intussusception caused by juvenile polyps and was successful in 9 patients (9/15, 60.0%). Colonoscopic polypectomy was subsequently performed in 8 patients and was successful in 7 patients (7/8, 87.5%). The other patient had undergone laparoscopic exploration, and no abnormality was found. Subsequently, the patient underwent open surgery. The patients with colocolic intussusception caused by other pathologic lead points almost underwent surgical treatment (15/21, 71.4%), including 13 open surgeries and 2 laparoscopic surgeries.

Conclusion

A therapeutic enema followed by colonoscopic polypectomy is feasible to treat colocolic intussusception caused by juvenile polyps unless the patient has bowel perforation; however, surgery is sometimes needed. For patients with colocolic intussusception caused by other pathologic lead points, open surgery remains the primary treatment.

Beyond pancreatic insufficiency and liver disease in cystic fibrosis

Cystic fibrosis is a life shortening hereditary disease, primarily leading to progressive pulmonary infection and exocrine pancreatic dysfunction. Several gastrointestinal complications other than malabsorption can arise during the disease course and with the progressively increasing life span of patients with CF; new and more rare complications are being recognized. We review the literature on gastrointestinal manifestations in CF, excluding the liver and pancreas.

CONCLUSION

We describe the clinical presentation and treatment of more common conditions like gastroesophageal reflux, small intestinal bacterial overgrowth, intussusception, meconium ileus, distal intestinal obstruction syndrome, and constipation, and we also discuss what is known on celiac disease, appendicitis, fibrosing colonopathy, inflammation and inflammatory bowel disease and gastrointestinal cancer.

WHAT IS KNOWN

• Gastrointestinal complications arise early in the course of the disease and have a severe impact on the quality of life of the patients. What is New: • This review is a concise summary of the current literature on gastrointestinal complications of cystic fibrosis. • We focused on clinical presentation and diagnostic investigations and provide a comprehensive resume of the current treatment options.

Idiopathic simultaneous intussusceptions in a neonate

Multiple simultaneous intussusception is a peculiar variety of intussusception. The condition is reported in older children and adults. The occurrence in neonates is an interesting situation. We present one such neonate who had a simultaneous ileo-colic and ileo-ileal intussusception without any specific cause. A review of existing literature revealed only three neonates. The terminology and various aspects of the condition are discussed.

Common characteristics of jejunal heterotopic gastric tissue in children: a case report with review of the literature

An 11-year-old boy underwent laparotomy for intermittent intussusceptions because of a polypoid lesion located in the proximal jejunum. The polypoid lesion was diagnosed as heterotopic gastric mucosa (HGM). Jejunal HGM is a very rare entity, and review of the literature revealed common characteristics in children with this pathologic condition. The usual presenting age is about 14 years, and the common clinical picture is intermittent intussusceptions. Jejunal HGM is usually polypoid and predominantly located within a few centimeters distal to ligament of Treitz. The aforementioned characteristics should suggest jejunal HGM be included in the differential diagnosis of jejunal polypoid lesions in children.

Multiple sequential intussusceptions causing bowel obstruction in a preterm neonate

We present a case of multiple sequential intussusceptions in a preterm neonate that resulted in mechanical bowel obstruction. The differential diagnosis of abdominal obstruction in a neonate is extensive, requiring a thorough review of presentation and methodical workup to determine etiology (Teitelbaum DH. Obturation obstruction of the intestine. In: O'Neill JA, editor. Principles of pediatric surgery. St. Louis (MO): Mosby, 2003. p. 605-612). Rare causes must be considered in a patient with no obvious etiology on contrast studies and persistent symptoms. Intussusception, a common cause of obstruction and pain in older infants and children, can rarely occur in neonates and is unfortunately difficult to diagnose preoperatively (J Pediatr. 1955;47:87-94; Pediatr Surg Int. 1998;13:232-236; Ann Saudi Med. 2000; 20:310-312; Eur J Pediatr. 1999;158:830-832; J Paedatr Child Health. 2004;40:388-391; Radiology. 1977;125:463-466; J Perinat Med. 2004;32:190-194).