Severe colic mimicking intussusception: a new phenomenon

Area of Science:

• Pediatric Gastroenterology
• Diagnostic Imaging
• Abdominal Pain Management

Background:

• A novel phenomenon of severe abdominal colic in children has been observed over the past five years.
• Patients present with a distinct clinical picture of sudden, acute, severe abdominal colic accompanied by continuous screaming for 1-2 minutes.

Purpose of the Study:

• To describe and highlight a newly identified cause of severe abdominal pain in pediatric patients.
• To differentiate this condition from acute intussusception, which is the initial clinical and ultrasonographic diagnosis.

Main Methods:

• A retrospective study of 11 children aged 9 months to 5 years presenting with acute severe abdominal colic between 2009 and 2014.
• Review of clinical data, ultrasonography (US), abdominal X-rays, and diagnostic gastrografin enemas.

Main Results:

• Initial diagnosis in all cases was intussusception, supported by US findings mimicking the condition.
• Radiological evaluation revealed fecal impaction of the terminal ileum and cecum as the underlying cause.
• Diagnostic enemas excluded intussusception and confirmed fecal impaction, with a significant response to enema treatment.

Conclusions:

• Severe abdominal pain in children can be attributed to fecal impaction of the terminal ileum and cecum, a phenomenon requiring increased clinical awareness.
• Recognizing this condition can prevent misdiagnosis, unnecessary investigations, and potentially harmful surgical exploration.