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Recalcitrant intussusception: exploring potential associations with Helicobacter pylori infection - a case report and
Kuan-Chieh Wang1,2, Chun-Hao Chu3,4, Che-Ming Chiang4
1School of Medicine, National Defense Medical Center, Taipei, Taiwan.
Insights
Helicobacter pylori infection can trigger Henoch-Schönlein purpura (HSP), leading to recurrent intussusception in children. Treating H. pylori resolved intractable cases, suggesting it as a potential underlying cause.
Area of Science:
- Pediatrics
- Gastroenterology
- Infectious Diseases
Background:
- Intussusception is a common cause of abdominal pain in children, often idiopathic.
- Recurrent intussusception raises clinical concerns, with factors like Henoch-Schönlein purpura (HSP) implicated.
- The role of Helicobacter pylori (H. pylori) in recurrent pediatric intussusception is unexplored.
Purpose of the Study:
- To investigate the potential link between H. pylori infection, HSP, and recurrent intussusception.
- To explore H. pylori as an underlying pathogen in intractable intussusception cases.
Main Methods:
- A case study of a two-year-old girl with four episodes of intussusception and HSP.
- Evaluation of treatment response to steroids and subsequent H. pylori triple therapy.
Main Results:
- The patient experienced recurrent intussusception coinciding with HSP, refractory to steroid treatment.
- Identification and treatment of H. pylori infection led to complete resolution of intussusception.
Conclusions:
- H. pylori infection can trigger HSP, leading to recurrent intussusception.
- In cases of intractable intussusception with steroid-resistant recurrent HSP, H. pylori should be considered a potential pathogen.
Background:
Intussusception, a common cause of abdominal pain in children, often lacks clear underlying causes and is mostly idiopathic. Recurrence, though rare, raises clinical concerns, with rates escalating after each episode. Factors like pathological lead points and Henoch-Schönlein purpura (HSP) are associated with recurrent cases. On the other hand, the prevalence of Helicobacter pylori (H. pylori), often asymptomatic, in children has been declining. Although its infection is reported to be linked with HSP, its role in recurrent intussusception remains unexplored. Further research is needed to understand the interplay among H. pylori (culprit pathogen), HSP (trigger), and intractable intussusception so as to develop effective management strategies.
Case Presentation:
A two-year-old girl experienced four atypical episodes of intussusception at distinct locations, which later coincided with HSP. Despite treatment with steroids, recurrent intussusception persisted, suggesting that HSP itself was not a major cause for intractable presentations. Subsequent identification of H. pylori infection and treatment with triple therapy resulted in complete resolution of her recalcitrant intussusception.
Conclusion:
This instructive case underscored a sequence wherein H. pylori infection triggered HSP, subsequently resulting in recurrent intussusception. While H. pylori infection is not common in young children, the coexistence of intractable intussusception and steroid-resistant recurrent HSP necessitates consideration of H. pylori infection as a potential underlying pathogen.
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