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Intussusception in an infant with acute lymphoblastic leukemia: a case report and review of the literature
M V Manglani1, J Rosenthal, N F Rosenthal
1Division of Pediatric Hematology-Oncology, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, USA.
Insights
Intussusception is a rare gastrointestinal complication in children with acute lymphoblastic leukemia (ALL). This case highlights a successful surgical and chemotherapy approach for ileocecal intussusception during ALL induction therapy.
Area of Science:
- Pediatric Oncology
- Gastroenterology
- Surgical Pathology
Background:
- Acute lymphoblastic leukemia (ALL) is a common childhood cancer.
- Gastrointestinal complications, including intussusception, are infrequent during ALL treatment.
- Early recognition and management are crucial for favorable outcomes.
Observation:
- A 7-month-old infant with B-lineage ALL developed ileocecal intussusception during induction chemotherapy.
- Symptoms included abdominal distension and hypoactive bowel sounds.
- Diagnosis was confirmed via barium enema and CT scan.
Findings:
- Surgical intervention (reduction and resection) was performed successfully.
- Histopathology revealed leukemic cell infiltration and necrosis at the intussusception site.
- Chemotherapy was resumed after a 1-week delay, leading to complete remission.
Implications:
- This case underscores the importance of considering intussusception in children with ALL presenting with abdominal symptoms.
- Prompt diagnosis and multidisciplinary management (surgical and oncologic) are vital.
- Further research into the etiology and prevalence of intussusception in pediatric leukemia is warranted.
Purpose:
An ileocecal intussusception developed in a 7-month-old infant with acute lymphoblastic leukemia (ALL) during induction therapy. Gastrointestinal complications, especially intussusception, are rare in children with ALL.
Patient And Methods:
The history of a 7-month-old white boy with ALL in whom an ileocecal intussusception developed 1 week into induction chemotherapy was reviewed. In addition, a literature search was performed to determine the prevalence of this complication in children with acute leukemia.
Results:
On day 4 of induction chemotherapy for B-lineage ALL, the infant developed abdominal distension with hypoactive bowel sounds. After a barium enema and abdominal computed tomography scan, the symptoms were determined to be caused by an ileocecal intussusception. Chemotherapy was resumed 1 week after immediate surgical intervention (reduction of intussusception and resection of the "leading edge") with an uneventful post-operative recovery. Histopathologic examination of the resected edge revealed an intact mucosa with areas of necrosis in the submucosa. This was associated with a dense lymphoid infiltrate composed of mature lymphocytes and leukemic cells, edema, and focal necrosis. Despite a 1-week delay in chemotherapy, a complete remission was documented at day 32.
Discussion:
The prevalence of intussusception in children with ALL and its possible etiology are discussed. The pathologic changes, clinical manifestations, and treatment outcome are briefly mentioned.
