- Case study
- Open Access
Adenomyoma of the small intestine a rare pathological lead point for intussusception in an infant
© Bak et al.; licensee Springer. 2014
Received: 24 July 2014
Accepted: 8 October 2014
Published: 18 October 2014
Intussusception is a typical abdominal emergency in early childhood.
We report a case of an infant in the typically affected age group with an intussusception triggered by a rare benign intramural intestinal adenomyoma as a pathological lead point. The infant had the typical symptoms of a recurrent idiopathic ileocolic intussusception.
Discussion and evaluation
Idiopathic intussusception is frequent in the infant age group. Contrary to that, reports on pathological lead points for intussusceptions are sparse in the toddler age.
That case illustrates that even in intussusceptions in the typically affected age group, it is important to be aware of pathological lead points, especially if the intussusceptions are recurrent.
Intussusception occurs when a proximal part of the bowel invaginates into a more distal part, typically within the ileocoecal region, which occurs commonly in infants and children between 3 months and 4 years of age. Typical symptoms in these patients include a triad of acute abdominal pain, vomiting and bloody stools; however, regularly, patients present with variable, non-specific symptoms. Ultrasonography is the established standard for diagnosis of intussusception and has a high sensitivity and specificity (Lehnert et al. 2009). Idiopathic intussusception occurs due to swollen mesenteric lymph nodes in patients in the typically affected age group that have been affected by viral infection or non-specific immunologic factors. If recurrent intussusception or intussusception occur in older children, the presence of a pathological lead point must be considered. Herein, we report and discuss the case of an infant in the typically affected age group with an ileocolic intussusception triggered by an adenomyoma of the distal ileum wall, a rare benign intramural intestinal tumor, acting as pathological lead point.
Discussion and evaluation
Intussusception is a common cause of bowel obstruction in infants and toddlers, with the greatest incidence in infants aged 3–9 months (Lehnert et al. 2009, Gfrorer et al. 2009). There is a seasonal incidence, with peaks in spring and autumn resembling the most typical periods of seasonal gastroenteritis and respiratory tract infections. Most infants do not have a specific lead point. Hypertrophied Peyer’s patches and reactive lymph node hyperplasia, which result from prior viral infection, can serve as a lead point for idiopathic intussusception. Specific lead points (e.g., Meckel diverticulum, intestinal polyps, lymphomas, and intestinal duplication) are more commonly found in older children and adults. Ultrasonography is the preferred diagnostic tool in intussusception and has a sensitivity of 98-100% and a specificity of 88-100% (Lehnert et al. 2009, Gfrorer et al. 2009). Hydrostatic reduction under ultrasound control and contrast enema are established therapies for the treatment of intussusception, with a success rate of 70-90% (Lehnert et al. 2009, Gfrorer et al. 2009). Immediate surgery is indicated in patients who have peritonitis, sepsis, evidence of perforation, unsuccessful non-operative repositioning or a clear finding of pathological lead points. In cases occurring in individuals not in the typical age group or in cases of recurrent intussusceptions, a pathological lead point must be excluded.
Previous reported cases of adenomyoma in intussusception
Schwartz et al.
Gal et al.
Kim et al.
Gal et al.
Lamki et al.
Serour et al.
Chan et al.
Gonzalvez et al.
Yamagami et al.
Lee et al.
Park et al.
Mouravas et al.
Takeda et al.
here described case
Adenomyoma of the small bowel is a rare cause of intussusception in all age groups. The here presented case shows, that even in patients where intussusceptions occur in the typically affected age group, it is important to be aware of pathological lead points, especially in recurrent intussusceptions.
Written informed consent was obtained from the parents for the publication of this report and any accompanying images.
We wish to acknowledge ML Hansmann (Institute of Pathology, Goethe-University Frankfurt/M.) for providing the histological images.
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