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Colonoscopic diagnosis of lymphoid hyperplasia causing recurrent intussusception: report of a case
1Division of Pediatric Surgery, Kinan General Hospital, Tanabe City, Wakayama, Japan.
Insights
Recurrent intussusception in a child was linked to ileocecal lymphoid hyperplasia. Colonoscopy aided diagnosis and management, leading to successful surgical resection and no recurrence.
Area of Science:
- Pediatric Gastroenterology
- Surgical Oncology
Background:
- Intussusception is a common surgical emergency in children.
- Recurrent intussusception can be challenging to diagnose and manage.
- Lymphoid hyperplasia is a potential, though less common, cause of intussusception.
Observation:
- A 6-year-old boy presented with recurrent ileocecal intussusception.
- Initial diagnosis by ultrasound and treatment with barium enema were followed by multiple recurrences.
- Colonoscopy revealed terminal ileum folds and lymphoid hyperplasia, identified as the cause.
Findings:
- Colonoscopy and biopsy confirmed lymphoid hyperplasia as the etiology of intussusception.
- Ileocecal resection resolved the recurrent intussusception without further episodes.
- Preoperative colonoscopy proved crucial for accurate diagnosis and treatment planning.
Implications:
- Colonoscopy is a valuable tool for diagnosing lymphoid hyperplasia in pediatric intussusception.
- Early diagnosis of lymphoid hyperplasia can prevent recurrent intussusception episodes.
- This case highlights the importance of endoscopic evaluation for unexplained recurrent intussusception.
Abstract:
This paper describes a 6-year-old boy with recurrent ileocecal intussusception due to lymphoid hyperplasia in the terminal ileum, which was diagnosed preoperatively by colonoscopy. At the age of 3 years, he developed diarrhea and a tender abdominal mass. He was diagnosed as having intussusception by ultrasound and was treated by hydrostatic barium enema. After resolution, he had three recurrent episodes of intussusception. A contrast barium enema revealed a small mass in the ileocecal region. Colonoscopy showed several exaggerated folds of the terminal ileum and a biopsy showed lymphoid hyperplasia. Because the repeated intussusception seemed to have been caused by the lymphoid hyperplasia in the terminal ileum, he underwent an ileocecal resection without any subsequent recurrence. Based on the above findings, we conclude that a colonoscopy may thus be useful both for diagnosing lymphoid hyperplasia in the terminal ileum as a cause of recurrent intussusception and for deciding how to manage it.