Abstract
Chronic intussusception, defined as intussusception continuing over 14 days, is rare in children. We herein report a case of chronic ileocolic intussusception caused by the transmural infiltration of diffuse large B cell lymphoma in a 14-year-old boy. The patient had been suffering from anorexia and intermittent abdominal pain for 5 weeks, during which his body weight decreased by around 7 kg. Upon admission to our hospital, ultrasonography and enhanced computed tomography (CT) of the abdomen showed ileocolic intussusception. A retrospective examination of abdominal CT led us to suspect that the intussusception had initially appeared 5 weeks before admission, presumably coinciding with the beginning of the patient’s abdominal symptoms. Since hydrostatic reduction was unsuccessful, laparotomy was performed, which showed unreducible ileocolic intussusception with a marked edematous ileum and mesentery. Ileocecal resection without lymph node dissection was carried out, and a histological examination of the resected specimen revealed the transmural infiltration of diffuse large B-cell lymphoma of the terminal ileum. The patient’s postoperative course was uneventful, and adjuvant chemotherapy was administered. This case illustrates the diagnostic challenges of confirming ‘chronic’ intussusception in older children.
Highlights
Intussusception is usually an acute condition and is readily diagnosed based on a typical pattern of abdominal pain, “currant jelly” bloody stools and vomiting in children under 2 years old (Schulman et al 1998)
We report a case of chronic ileocolic intussusception resulting from the transmural infiltration of diffuse large B-cell lymphoma
Diarrhea and “currant jelly” bloody stools were not present at that time, the stool was positive for occult blood
Summary
Intussusception is usually an acute condition and is readily diagnosed based on a typical pattern of abdominal pain, “currant jelly” bloody stools and vomiting in children under 2 years old (Schulman et al 1998). We report a case of chronic ileocolic intussusception resulting from the transmural infiltration of diffuse large B-cell lymphoma. Case report A 14-year-old boy showing paroxysmal kinesigenic dyskinesia was referred to our hospital He had been suffering from anorexia, nausea, abdominal pain and weight loss of 7 kg for 5 weeks. An examination of abdominal CT performed at the previous clinic 5 weeks earlier made us suspicious of signs of ileocolic intussusception (Figure 2). We performed probe laparoscopy, which revealed ileocolic intussusception, serous ascites and a markedly edematous ileum and mesentery (Figure 3). This CT was performed 5 weeks before he admitted to our hospital. The postoperative course was uneventful, and the patient was transferred to the hematology unit of another hospital 2 weeks after the operation, at which time adjuvant chemotherapy was administered
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