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Presenting features and treatment of small intestinal adenomyosis in children: a 10-year retrospective study
Huan-Sheng Wang1, Ke-Hua Huang2, Ren-Sen Jiang2
1Department of General Surgery, Shenzhen Children's Hospital of China Medical University, Shenzhen, Guangdong, China.
Insights
Small intestinal adenomyosis is a rare condition more common in males, often presenting with intussusception in young children. Surgical resection offers a favorable prognosis for this rare small bowel tumor.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Pathology
Background:
- Small intestinal adenomyosis is a rare benign tumor.
- It predominantly affects male infants and young children.
- Clinical presentation often involves intussusception.
Purpose of the Study:
- To analyze and summarize the clinical characteristics of small intestinal adenomyosis in children.
- To review diagnostic and treatment approaches.
- To evaluate patient outcomes.
Main Methods:
- Retrospective analysis of six pediatric cases (2014-2024).
- Inclusion of data on age, gender, symptoms, imaging, pathology, and treatment.
- Surgical resection and pathological examination of resected specimens.
Main Results:
- Male predominance (5:1 ratio), median age 19 months (two-thirds < 2 years).
- Common presentation with intussusception; challenging for non-operative reduction.
- Ileal location common; surgery yielded favorable outcomes. Histopathology showed glandular-like structures.
Conclusions:
- Small intestinal adenomyosis is more common in males, presenting with intussusception.
- Abdominal ultrasound aids in diagnosis, showing characteristic features.
- Surgical management is effective with good prognosis.
Objective:
This study aims to analyze and summarize the clinical characteristics of small intestinal adenomyosis.
Methods:
A retrospective study was conducted on children with small intestinal adenomyosis at our center from 2014 to 2024. The age of onset, gender, clinical symptoms, auxiliary examination results, treatment plans, and pathological characteristics of the tumors were recorded and analyzed.
Results:
Six cases of small intestinal adenomyosis were analyzed. The male-to-female ratio was 5:1. The median age was 19 months, with two-thirds of the affected children being under 2 years old. Two cases were identified in newborns during the treatment of intestinal malrotation. The remaining patients developed symptoms of intussusception. Preoperative ultrasound identified pathological lead points in two cases. Among the six cases, one case's adenomyoma was located in the jejunum, while the rest was located in the ileum, with tumors ranging from 25 to 140 cm from the ileocecal region. All six patients underwent resection of the tumor segments in the small intestine followed by anastomosis; postoperative prognosis was favorable. Of the six pathological results, glandular-like structures were found in five tumors, with three cases lined with cuboidal or columnar epithelium and one case lined with stratified or squamous epithelium.
Conclusions:
Small intestinal adenomyosis is observed to be more prevalent in male, with onset ages ranging from six days to four years. It frequently coexists with recurrent intussusception, making reduction with air or water enema challenging. Abdominal ultrasound typically shows tumors at the leading edge of the intussusception, with compromised blood flow signals and multiple small cystic or honeycomb-like anechoic structures. Surgery is the primary treatment and generally results in a favorable prognosis.
