Acute ileo-ileal intussusception following a Swenson procedure in a resource-limited setting: a case report

Unexpected postoperative complications associated with the Swenson procedure for the surgical management of Hirschsprung's disease are rarely documented, and postoperative intussusception following this technique is seldom reported. We present a case of acute ileo-ileal intussusception occurring after the Swenson procedure.

The patient was a 12-month-old infant who, 16 days after undergoing a Swenson resection, presented with rectal bleeding and abdominal distension. A plain abdominal X-ray demonstrated features of intestinal obstruction, while a longitudinal ultrasound scan revealed a "sandwich" sign, leading to a suspected diagnosis of intussusception. A laparotomy was subsequently performed; intraoperative findings of ileal necrosis necessitated ileal resection and anastomosis. The patient's postoperative course was favorable, and he was discharged on the seventh day.

This unusual case suggests the existence of a functional mechanism, even in the absence of an identified anatomical cause. According to Swenson, post-surgical intestinal intussusception is uncommon but should be taken into account when making a differential diagnosis for any mechanical intestinal blockage that develops following surgery.

Any child who has undergone a Swenson procedure and subsequently presents with rectal bleeding and other signs of intestinal obstruction should undergo advanced diagnostic evaluation to exclude intussusception. The necessity of establishing a postoperative follow-up protocol in resource-limited settings is evident.