Yersinia enterocolitica in a child with intussusception.

Abstract

Intussusception is a common cause of bowel obstruction in infants and young children. In all, 75-90% of the cases of ileocolic intussusception are idiopathic (1). The remainder have a pathological lead point, such as a hamartomatous polyp, lymphoma, Meckel's diverticulum, juvenile vascular malformation, duplication cyst, or bowel wall hematoma (2,3). A role for viral and bacterial enteric infection in idiopathic intussusception has been proposed. Patients with intussusception have been reported to shed adenovirus, rotavirus, enterovirus, herpes simplex, and human herpes 6 virus in their stools (4-10). The association of adenovirus and rotavirus has been addressed in several studies (4-8). Adenovirus was isolated in 39% of cases when pharyngeal and rectal swabs were obtained from patients with intussusception (4). When appendixes removed from children with intussusception were examined, adenovirus was found in a majority by the presence of typical intranuclear inclusions and viral DNA by in situ hybridization (7). Montgomery and Popek found intranuclear inclusions in 10 of 32 surgical specimens obtained from children with intussusception and lymphoid hyperplasia (11). Immunohistochemistry for adenovirus was positive in five of 16 specimens. Konno et al. found rotavirus in one-third of patients with intussusception (5); however, in a separate study, rotavirus was found in only two of 24 cases (8). Bacterial infection in intussusception has been described only sporadically (10-13). Salmonella typhimurium has been cultured in an adult with intussusception (13). Yersinia has been the only bacterial agent incriminated in children. Yersinia has been reported in three previous cases in the North American literature and seven previous cases worldwide (10-12,14,15). Of these cases, three in North America and five worldwide have specifically involved Yersinia enterocolitica. We report a case of intussusception occuring in association with a gastroenteritis-like illness in which Yersinia enterocolitica was ultimately cultured from the stools.