Case report- Is bowel resection always essential for treating recurrent intussusception in children?

China: Researchers from China have reported the first successful surgical treatment of intestinal lymphoid hyperplasia (ILH)-induced pediatric intussusception recurrence (IR) in a 2 year old boy. 

"Our experience indicates that bowel resection may not be required if bowel necrosis and perforation are absent," Qingtao Yan, Department of Pediatric Surgery, Weifang People's Hospital, Weifang, China, and colleagues wrote in their case study. 

Intussusception recurrence induced by ILH is rare in children, and surgical treatment is the final resort in cases where IR is refractory to medications and non-surgical interventions. Till now, only a few case reports have described surgical management of ILH-induced IR in children, all involving bowel resection regardless of whether there are bowel necrosis and perforation.

In the study, published in the journal BMC Surgery, the researchers have described the case of a 2 year old boy who was admitted due to IR. Main complaint was abdominal pain. Color Doppler ultrasound confirmed ileocecal intussusception while no other abnormalities were found. A final diagnosis was made of intussusception recurrence with unknown causes. 

Repeated saline enema reductions and dexamethasone was not able to cure the IR. Eventually, laparotomy was performed after almost 10 episodes of IR. Intraoperatively, distal ileum thickening with palpable masses without bowel necrosis and perforation was noted.

ILH was suspected and performed a biopsy of the affected intestine. Histopathological analysis confirmed ILH. The intussusception was manually reduced, the terminal ileum and the ileocecal junction were fixed to the paralleled ascending colon and the posterior peritoneum respectively, and no bowel resection was performed. 

The postoperative recovery was uneventful and during over 5 years of follow-up no IR was observed. 

To conclude, the case report provides two important tips regarding the diagnosis and treatment of ILH-induced IR in children. First, if imaging and other exams are not able to determine IR cause in children, ILH should be highly suspected, and biopsy pathology is the key for ILH identification. Secondly, when when medications and non-surgical interventions fail to cure IR, bowel resection may be avoided during surgical procedures if bowel necrosis and perforation are absent.

"We hope this case report will spur more clinicians to share their experiences in surgical treatment of ILH-induced IR without bowel resection in cases similar to ours," the researcher concluded.

Reference:

Wang, H., Li, H., Xin, W. et al. Surgical treatment of recurrent intussusception induced by intestinal lymphoid hyperplasia in a child: is bowel resection always necessary? A case report. BMC Surg 22, 169 (2022). https://doi.org/10.1186/s12893-022-01608-w