Distal colo-colonic intussusception caused by Burkitt's lymphoma

Abstract

Intussusception in the pediatric population is most commonly identified in children under two years of age in the ileocecal region. Our case is a rare example of distal colo-colonic intussusception in a seven-year-old male. After air contrast enema reduction of the intussusception, he was found on fluoroscopic images and CT scan to have an intraluminal lead point in the splenic flexure that resulted in almost immediate recurrence and was unresectable endoscopically. He underwent a laparoscopic-assisted partial left colectomy. Final pathology confirmed the diagnosis of Burkitt's lymphoma. There is a paucity of guidance with regards to colo-colonic intussusception with suspicion for a pathologic lead point. Based on our experience, after reduction by air enema, we recommend imaging, colonoscopy with either resection or biopsies, and surgical resection if necessary to remove the lead point and establish a tissue diagnosis. Based on both the high likelihood of lymphoma and its responsiveness to chemotherapy, we recommend grossly negative margins with lymph node sampling rather than traditional oncologic resection with complete lymphadenectomy.