Abstract
IntroductionIntussusception involving heterotopic pancreatic tissue is a rare condition where a portion of the bowel telescopes into an adjacent segment with intraluminal pancreatic tissue as the lead point. Cases of heterotopic pancreas are most often described in the upper intestinal tract, particularly the stomach.Case presentationWe present the case of a five-month-old boy of Caucasian ethnicity suffering acute abdominal pain and vomiting with an abdominal mass in the upper right quadrant. Work-up including ultrasound scan confirmed the intussusception. Repeated attempts at radiological reduction and two laparoscopic procedures were performed within 24 hours, which eventually led to the diagnosis of a triple intussusception.ConclusionTo our knowledge, such a case of triple intussusception involving isolated heterotopic pancreatic tissue is previously unreported.
Highlights
Intussusception involving heterotopic pancreatic tissue is a rare condition where a portion of the bowel telescopes into an adjacent segment with intraluminal pancreatic tissue as the lead point
A triple intussusception occurs when three separate segments telescope into the same distal segment
The diagnosis could not be made after the first laparoscopy and, as a matter of fact, only one intussuscepted loop was reduced at first
Summary
Intussusception is a not uncommon surgical problem occurring in children. It is defined as a prolapse of part of the intestine into the lumen of an immediately adjoining part. A five-month-old boy of Caucasian ethnicity presented at our pediatric emergency unit He had suffered acute paroxysmal abdominal pain and bilious vomiting for nine hours. Journal of Medical Case Reports 2009, 3:134 http://www.jmedicalcasereports.com/content/3/1/134 loop in the transverse colon that was refluxing under air pressure This procedure did not result in a complete reduction of the assumed intussusception even after two attempts under midazolam infusion. An ultrasound scan performed in the morning revealed an intussusception, a swelling of the distal small intestine and the presence of a mass in the pouch of Douglas. The small intestine was examined more closely and an intussusception was found, located 40 cm above the ileocolic junction. The second intussusception, which formed an additional loop on the first one, was located 40 cm away from the ileocolic junction. The third intussusception completed the telescoping in the ascending colon (Figure 2)
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