Dataset Information

Concomitant intussusception and appendicitis "appendi-sception" in children: A case report and review of literature.

ABSTRACT:

Introduction

Pediatric intussusception is the leading cause of bowel obstruction in children under 2 years of age. Concurrent intussusception and appendicitis, known as "appendi-sception" is exceptionally rare in the pediatric population.

Case presentation

A 37-month-old boy presented with periumbilical abdominal pain, vomiting, and red currant jelly stool for two weeks. Clinical examination and ultrasonography confirmed intussusception. Hydroreduction was attempted twice but failed, necessitating surgical intervention. During exploratory laparotomy, ileocolic intussusception and an inflamed appendix were discovered for which an appendectomy was performed. The postoperative course was uneventful, and histopathology confirmed suppurative appendicitis. The patient had no difficulty at the one-year follow-up.

Discussion

Intussusception with appendicitis as a lead point is rare and often challenging to diagnose preoperatively. The literature review revealed 11 pediatric cases, with concomitant intussusception and appendicitis highlighting diagnostic challenges due to symptom overlap. The overlap in symptoms between intussusception and appendicitis complicates diagnosis. Hydroreduction failure should prompt consideration of secondary causes, including appendicitis.

Conclusion

Considering secondary causes in intussusception is crucial, especially when initial management fails. CT scans should be considered in such cases. Appendectomy and manual reduction can effectively manage concurrent intussusception and appendicitis. This case underscores the importance of considering multiple diagnoses in complex pediatric abdominal presentations.

SUBMITTER: Bhattarai B

PROVIDER: S-EPMC11340584 | biostudies-literature | 2024 Jul

REPOSITORIES: biostudies-literature

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Publications

Concomitant intussusception and appendicitis "appendi-sception" in children: A case report and review of literature.

Bhattarai Bhawesh B Paudel Sujan S Luitel Prajjwol P Shrestha Asim A Poudel Bibek B Koirala Dinesh D

International journal of surgery case reports 20240709

<h4>Introduction</h4>Pediatric intussusception is the leading cause of bowel obstruction in children under 2 years of age. Concurrent intussusception and appendicitis, known as "appendi-sception" is exceptionally rare in the pediatric population.<h4>Case presentation</h4>A 37-month-old boy presented with periumbilical abdominal pain, vomiting, and red currant jelly stool for two weeks. Clinical examination and ultrasonography confirmed intussusception. Hydroreduction was attempted twice but fail ...[more]

PMID: 39084125

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Project description:BackgroundAdult-onset colonic intussusception is a rarely encountered condition that leads to large intestinal obstruction with time. Patients often present with a variety of symptoms that are non-specific making it challenging to arrive at a definitive diagnosis. This is worrying as diagnostic delay could lead to a significant increase in morbidity and mortality. We wish to present and describe a case of an atypical endoscopic finding of colocolic intussusception secondary to ascending colon cancer.Case descriptionSixty-seven-year-old lady was referred for 1 month's duration of passing melenic stools with mucus followed by a week's complain of hematochezia. Clinical examination and other relevant blood results were unremarkable except for iron deficiency anemia. Initial colonoscopy revealed a large mass within the splenic flexure with inconclusive biopsies. A more detailed colonoscopy repeated the following day revealed a massive, black-to-yellowish lesion within the splenic flexure with no viable mucosa seen. Colonic bezoar was initially suspected, however various endoscopic retrieval methods proved futile. Switching to a slimmer diagnostic gastroscope, the colon was carefully negotiated until a large ulcer was found within the ascending colon, adjacent to the mass' origin. An emergency CT abdomen and subsequently extended right hemicolectomy performed revealed a colocolic intussusception with sealed perforation secondary to an ascending colonic mass acting as an intussusceptum. Histopathology evaluation confirmed an ascending colon adenocarcinoma (pT2N0M0) amidst a background of extensive ischemic changes.ConclusionsEndoscopic descriptions of colonic intussusception are unusual given their rarity. Furthermore, these lesions can mimic a colonic bezoar as a result of fecal accretion and this can ultimately lead to false diagnostic and therapeutic decisions. In such instances, clarification with a CT scan before management decision can potentially avert unnecessary endoscopic intervention and complications.

Project description:Background: One of the most serious complications of cranial radiotherapy is the development of radiation-induced glioma, which is estimated to occur in 1 to 4% of patients who have received cranial irradiation and has a worse prognosis than sporadic glioblastoma. To date, owing to its rarity, no standard of care has been established for radiation-induced glioma. Although comprehensive genetic analysis has recently uncovered the molecular characteristics of radiation-induced glioma, the full picture remains unclear, and the molecular features associated with treatment response and prognosis are poorly understood. Case presentation: A 45-year-old man presented with generalized seizures caused by multiple brain tumors involving the right frontal lobe, thalamus, and brainstem. The patient had a history of whole-brain radiotherapy for the recurrence of Burkitt's lymphoma at the age of 12. He underwent craniotomy, and the histological diagnosis was a high-grade glioma with isocitrate dehydrogenase-wildtype, which was presumed to be a radiation-induced glioma that developed 33 years after whole-brain irradiation. The Heidelberg DNA-methylation brain classifier most closely matched diffuse pediatric-type high-grade glioma, receptor tyrosine kinase-1 subtype, which is a typical methylation class of radiation-induced glioma. Methylation-specific polymerase chain reaction showed that the O6-methylguanine-DNA methyltransferase gene promoter was unmethylated. Next-generation sequencing identified CDKN2A/B deletion as well as co-amplification of several receptor tyrosine kinase-encoding genes including PDGFRA, KIT, and KDR, which are all located on chromosome 4q12. Amplification of this region is present broadly across cancers and is associated with a poor prognosis in sporadic glioblastoma. Nevertheless, the patient received conventional chemoradiotherapy with temozolomide. Subsequent multimodal imaging with magnetic resonance imaging and 11C-methionine positron emission tomography revealed complete remission of all lesions. Two years later, the patient is currently alive with a favorable performance status. Conclusions: Despite radiation-induced glioma with molecular features suggestive of an aggressive phenotype, our patient unexpectedly responded well to conventional chemoradiotherapy, resulting in complete remission that is exceptional in sporadic glioblastoma. Our case indicates that some of the radiation-induced gliomas may have distinct molecular characteristics involved in the therapeutic response that differ from those of sporadic glioblastomas.

Dataset Information

Concomitant intussusception and appendicitis "appendi-sception" in children: A case report and review of literature.

Introduction

Case presentation

Discussion

Conclusion

Publications

Concomitant intussusception and appendicitis "appendi-sception" in children: A case report and review of literature.

Similar Datasets

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