Colocolic Megacolon Intussusception: Diagnostic Challenges and Surgical Management

Intussusception in children may present in typical or atypical manner. These presentations sometimes typify the background etiopathophysiology. It may be primary (idiopathic) or secondary in origin depending on the presence or absence of an identifiable pathologic lead point (PLP). The idiopathic category is seen in 90% of intussusception cases in children. The secondary categories have varying pathological lead points, with some still unreported. This report narrates our experience in the management of a 6-year-old child with a colocolic megacolon intussusception. It was characterized by a subtle history of chronic constipation and solid diet intolerance. Long-standing colicky abdominal pain was interpreted as a food allergy, and this was a critical clinical miss. Radiographical megacolon appearance on X-ray was misinterpreted as a dilated gastric shadow. Ultrasound evaluation was diagnostic, but this could not distinguish the PLP. Surgical intervention was planned for ileocolic intussusception; however, a colocolic intussusception was encountered, and an inappropriate intraoperative decision to perform a pry colo-colonic anastomosis was taken. Atypical septic-induced persistent bradycardia and severe lethargy were danger signs of anastomotic leakage that necessitated a re-exploration laparotomy and a lifesaving diverting colostomy. A definitive Duhamel pull-through procedure was carried out after 11 months of optimization. Management was challenging and required an aggressive and proactive approach. We recommend a high index of suspicion in making a diagnosis and a diverting colostomy in the emergency surgical intervention for all secondary colo-colic megacolon intussusception.