Appendi-sception unveiled: a case report of a toddler with concurrent ileocolic intussusception and appendicitis

Ileocecal (ileocolic) intussusception is a time-critical pediatric surgical emergency and a leading cause of acute bowel obstruction in infants and toddlers. Acute appendicitis, although the most common pediatric surgical emergency overall, is uncommon in very young children and is diagnostically challenging at the extremes of age. The coexistence of ileocolic intussusception with acute appendicitis, often termed "appendisception," is rare and frequently recognized during surgery.

We report a 1-year-9-month-old child who presented with features consistent with ileocecal intussusception. Initial evaluation and imaging supported the diagnosis. The patient proceeded to operative management, where intraoperative findings unexpectedly revealed an inflamed appendix, consistent with acute appendicitis, within the intussuscepted segment. Surgical reduction of the intussusception and appendectomy were performed, with an uneventful postoperative recovery.

This case underscores important diagnostic pitfalls in young children, in whom overlapping clinical features may obscure dual pathology. Intussusception may mask appendicitis, while appendiceal inflammation can act as a pathological lead point. Ultrasound remains the first-line imaging modality, but careful evaluation of the appendix is recommended, particularly in atypical or recurrent cases, or following failed enema reduction. Awareness of appendiceal intussusception is essential to guide timely operative decision-making.

Although rare, the coexistence of ileocolic intussusception and acute appendicitis should be considered in infants and toddlers with atypical presentations or failed nonoperative reduction. A high index of suspicion, meticulous imaging, and pragmatic surgical management are crucial to optimizing outcomes.