Double intussusception: a rare case report and review of the literature
Rojan Singh Dangol, Bimarsh Acharya, Bijay Panday, Mandeep Dutta Joshi, Kushal SubediIntroduction and importance:
Intussusception is one of the most common abdominal emergencies in childhood, characterized by the telescoping of a proximal bowel segment into the adjacent distal segment. While single-site intussusception is frequently encountered, double or simultaneous intussusception is exceedingly rare. Delay in diagnosis and management can lead to catastrophic complications, including bowel ischemia, necrosis, and perforation.
Case presentation:
We report a rare case of double intussusception involving jejunojejunal and ileoileal segments in a male adolescent presenting with acute abdominal pain, vomiting, bloody mucoid stool, and a palpable abdominal mass. Radiological evaluation with ultrasonography and computed tomography suggested small bowel intussusception. Exploratory laparotomy revealed two distinct intussusceptions at separate sites of the small intestine, both associated with pedunculated polypoid masses acting as pathological lead points. Surgical management included reduction, resection of the proximal polyp-bearing segment with primary anastomosis (5 cm), and a barrel loop ileostomy for the edematous distal segment (30 cm) without primary resection. Postoperative recovery was uneventful, and the patient was discharged on day 12 with plans for stoma reversal and endoscopic surveillance.
Clinical discussion:
Double intussusception is clinically indistinguishable from single intussusception and is often diagnosed intraoperatively. Radiological modalities aid in early diagnosis; however, meticulous intraoperative exploration of the entire bowel is mandatory. The presence of pathological lead points, particularly intestinal polyps, necessitates surgical management.
Conclusion:
Double (simultaneous) intussusception is a rare but life-threatening condition. A high index of suspicion, thorough radiological assessment, and prompt surgical intervention, along with evaluation for pathological lead points, are essential to achieve favorable outcomes.