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The New England Journal of MedicineSmall-Bowel Intussusception in a Child

Identifying and Managing Pediatric Small-Bowel Intussusception: A Case of Ileoileal Intussusception in a Prematurely Born Child

A 3-year-old prematurely born boy presented with intermittent abdominal pain, nausea, and vomiting, leading to a diagnosis of ileoileal intussusception. This condition, the most common cause of bowel obstruction in children, often resolves spontaneously. Ultrasonography revealed characteristic findings, and the patient’s symptoms resolved without surgical intervention. Follow-up confirmed the absence of any pathologic lead point, classifying this episode as idiopathic.

Key Points:

  • Patient Presentation: A 3-year-old boy with a 1-day history of intermittent abdominal pain, nausea, and vomiting.
    • No bloody stools or recent illness contacts.
    • Normal vital signs; hypoactive bowel sounds and tenderness in the right lower quadrant.
  • Ultrasonography Findings:
    • Target-sign lesion in the right lower abdomen measuring 1.7 cm by 1.4 cm.
    • Longitudinal view showed a 2.4-cm segment of the small intestine telescoping into itself, known as the “sleeve sign.”
  • Diagnosis: Ileoileal intussusception.
  • Clinical Course:
    • Symptoms and ultrasonography findings resolved 30 minutes post-examination.
    • The patient was monitored in the hospital for one day without recurrence of abdominal pain.
    • Follow-up ultrasound three days later showed no mass or pathologic lead point.
  • Implications for Practice:
    • Intussusception is a leading cause of bowel obstruction in children.
    • Spontaneous reduction is common in small-bowel intussusception.
    • Ultrasonography is critical for diagnosis and monitoring.
    • Hospital observation is essential to ensure resolution and rule out recurrence or complications.
    • Recognizing idiopathic cases helps in avoiding unnecessary surgical interventions.

Intussusception is the most common cause of intestinal obstruction in patients aged 5 months to 3 years. Intussusception can account for as many as 25% of abdominal surgical emergencies in children younger than 5 years, exceeding the incidence of appendicitis. (Medscape)

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