Campylobacter jejuni-Induced Intussusception Recurrence Within a 30-hour Period

Abstract

Intussusception represents the most common etiology for intestinal obstruction in early childhood. It represents telescoping of the small bowel potentially resulting in ischemia and perforation. It is recognized as potentially recurrent in up to 10% of cases. A mass lesion providing a lead point is a risk factor for recurrence. Symptoms include acute intermittent abdominal pain, and bloody stools. Campylobacter jejuni is a gram-negative bacterium that causes enteritis and is known to cause intussusception. However, there are no reported cases of Campylobacter causing recurrent intussusception within a 30 hr period. We report a previously healthy 2 year old male who presented with a 7 day history of diarrhea, fever, 3 day history of bloody stools, spasmodic abdominal pain, and 1 self-limited episode of rectal prolapse. He was seen on 3 occasions in an emergency department. At the first visit, he was sent home with a kit for stool study, as he was unable to produce a bowel movement. On final return, an abdominal ultrasound reported short segment intussusception in the right lower quadrant. He developed recurrent ileocolic intussusception (3 recurrences total within 30 hours). All 3 episodes were successfully reduced via barostatic enema. For suspected lead point, he underwent exploratory laparoscopy; none was identified. After exploratory laparoscopy, his parent developed bloody stools prompting stool studies from our patient for investigation of infectious etiologies which were positive for Campylobacter jejuni. He was treated with Azithromycin. Small bowel obstruction from intussusception can complicate several luminal processes resulting in bowel wall thickening or mass acting as a lead point. While infectious etiologies are a risk factor for intussusception, this is the first report of recurrent intussusception associated with Campylobacter jejuni enteritis. In this case, stool collection for studies was unsuccessful until his parent presented with similar symptoms. Despite there being no recommendations currently for stool studies in the evaluation of intussusception in society guidelines, the authors would speculate that stool studies for enteric pathogens should be routinely obtained in children presenting with intussusception and treated wherever identified, potentially impacting the risk of recurrence. Current treatment recommendations for complicated cases of bacterial enteritis secondary to Campylobacter jejuni include macrolide antibiotics.