Intussusception in children: lessons learned from intestinal lymphoma as a rare lead-point

Area of Science:

• Pediatric Surgery
• Pediatric Oncology
• Gastroenterology

Background:

• Intussusception in children is typically idiopathic.
• Malignant conditions, like intestinal lymphoma, are rare causes of pediatric intussusception.
• The management of intestinal lymphoma presenting as intussusception requires careful consideration due to treatment implications.

Purpose of the Study:

• To evaluate the clinical presentation and management of pediatric intussusception caused by intestinal lymphoma.
• To highlight the importance of identifying pathological lead points in intussusception cases.
• To assess the role of reduction techniques and surgical intervention in lymphoma-associated intussusception.

Main Methods:

• Retrospective chart review of patients with intestinal lymphoma and intussusception from May 2011 to February 2017.
• Analysis of patient demographics, presenting symptoms, diagnostic imaging, reduction methods, and treatment outcomes.
• Inclusion of patients diagnosed with aggressive mature B cell non-Hodgkin lymphoma.

Main Results:

• Five pediatric patients (mean age 6.4 years) were identified.
• Abdominal pain was the most common presenting symptom, often with acute worsening.
• Ultrasound frequently suggested a pathological lead point; pneumatic/hydrostatic reduction was attempted in all, with one unsuccessful attempt and two recurrences.
• Two patients required surgery, and three underwent ultrasound-guided biopsy.
• All patients were diagnosed with aggressive mature B cell non-Hodgkin lymphoma.

Conclusions:

• A high index of suspicion for pathological lead points is essential in children over 4 years and those with recurrent intussusception.
• Malignant, aggressive B cell non-Hodgkin lymphoma should be actively investigated in these cases.
• Pneumatic or hydrostatic reduction should be the initial treatment approach for most intussusception cases, including those with suspected malignancy.