Purpose or Case Report: Ileocolic intussusception is a common diagnosis routinely treated by air or contrast enema in the pediatric setting. Cases become less common into the second decade of life with an inverse relationship with pathologic lead points as the inciting culprit. Idiopathic ileocolic intussusception in young pediatric patients has been correlated with seasonality and viral infections, leading to the hypothesis that lymphoid hypertrophy in the terminal ileum acts as the primary lead point in that patient population. Pediatric radiologists are vigilant in evaluation of underlying pathologic lead points in the older population including mechanical causes (Meckel diverticula, polyps, duplication cysts), lymphoma, or hematomas from bleeding disorders (IgA vasculitis, hereditary coagulopathies). Adult surgeons often operate on patients with ileocolic intussusception given the much higher propensity for pathologic lead points. A 20-year-old patient presented to the emergency room with acute onset severe colicky abdominal pain that awoke her from sleep. CT of the abdomen and pelvis was performed showing a right lower quadrant ileocolic intussusception. Patient was otherwise stable and referred to pediatric radiology for successful air enema reduction and planned for further outpatient work up of possible lead points. The patient experienced recurrence of symptoms 1 day later and was taken to the operating room where recurrent ileocolic intussusception was confirmed and ileocecetomy was performed. Pathologic examination of the specimen obtained during surgery revealed reactive lymphoid hyperplasia and multiple reactive mesenteric lymph nodes.
Methods & Materials:
Results:
Conclusions: This case presents a rare presentation of a common pediatric pathology. The absence of an operative mechanical lead point or malignancy in this patient highlights the importance of including the possibility of idiopathic intussusception in the differential of pediatric and adult clinicians. This case involving a patient on the margins of the pediatric age cohort illustrates the divergence of treatment pathways when presenting to a pediatric or adult facility, and therefore highlights the importance of communication and coordination of care for these patients.