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Laparoscopic management of delayed recurrent intussusception in an older child
Rahul J Anand1, Sohail R Shah, Timothy D Kane
1Division of Pediatric General and Thoracic Surgery, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA. anandrj@upmc.edu
Insights
Late recurrence of intussusception in children, though rare, warrants suspicion for a lead point. Surgical intervention is recommended over non-operative reduction for delayed recurrences.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Medical Imaging
Background:
- Intussusception is a leading cause of bowel obstruction in pediatric patients.
- While early recurrence is common, late recurrence years after initial episodes is infrequent.
Observation:
- A 13-year-old male experienced recurrent intussusception eight years after previous episodes at ages 2 and 5.
- Computed tomography confirmed the diagnosis.
- Laparoscopic ileocecectomy was performed with a successful postoperative outcome.
Findings:
- The surgical specimen revealed multiple enlarged lymph nodes on the ileal serosa.
- Histopathology showed focal edema, prominent lymphoid hyperplasia, and hemorrhagic areas.
Implications:
- This case underscores the importance of suspecting a lead point in delayed intussusception recurrences.
- Operative therapy is strongly advised for delayed recurrences, prioritizing it over hydrostatic reduction.
- Management strategies for recurrent intussusception should consider these findings.
Background:
Intussusception is the most common cause of bowel obstruction in infants and children. Although early recurrence is not uncommon, recurrence years later is rare.
Methods:
A 13-year-old male with a history of recurrent intussusception at ages 2 and 5 presented with recurrent intussusception 8 years later. The diagnosis was made using computed tomography, and the patient underwent a laparoscopic ileocecectomy with an uneventful postoperative course.
Results:
The specimen was remarkable for findings of multiple enlarged lymph nodes over the serosal surface of the ileum and the terminal ileum with focal edema, prominent lymphoid hyperplasia and large hemorrhagic areas.
Conclusion:
This case highlights the fact that in a child with a delayed recurrence of intussusception, the presence of a lead point should be suspected, and operative therapy should be strongly considered over hydrostatic reduction. The current management of recurrent intussusception is reviewed and applied to this case.
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