A Surprising Lead Point in an Ileocolic Intussusception

Abstract

Appendicitis and intussusception are 2 of the most common abdominal emergencies in children and have high rates of morbidity if not treated promptly. However, only rarely do they occur together. We present a case in which clinical suspicion for intussusception was not high. Point-of-care ultrasound (POCUS) was performed in the pediatric emergency department, revealing both ileocolic intussusception and appendicitis. This case reinforces the importance of maintaining a broad differential diagnosis in unclear clinical scenarios and of the potential utility of POCUS. In our case, identification of intussusception on POCUS facilitated expeditious treatment, identification of the lead point, and allowed the treating physicians to prepare for the possibility of surgical management.

Ruptured Appendicitis Within an Intussusception on Point-of-Care Ultrasound

“…[8][9][10][11][12][13] Point-of-careultrasound was used in only 1 case, and appendicitis (nonperforated) was a lead point for ileocolic intussusception. 13 In all but 1 of the cases initially diagnosed as intussusception on RADUS, the diagnosis of appendicitis as the lead point was made only after the patient failed reduction with pneumatic enema and was taken to the operating room. It is unclear in these cases whether the appendicitis develops as a result of compression and strangulation of the appendix trapped in the intussusception or whether the appendicitis acts as a lead point that causes the intussusception.…”

“…[4][5][6][7] Appendicitis within an intussusception is rare, and only a few cases in young children have been reported. [8][9][10][11][12][13] Point-of-careultrasound was used in only 1 case, and appendicitis (nonperforated) was a lead point for ileocolic intussusception. 13 In all but 1 of the cases initially diagnosed as intussusception on RADUS, the diagnosis of appendicitis as the lead point was made only after the patient failed reduction with pneumatic enema and was taken to the operating room.…”

“…Appendicitis within an intussusception is rare, and only a few cases in young children have been reported 8–13 . Point-of-care-ultrasound was used in only 1 case, and appendicitis (nonperforated) was a lead point for ileocolic intussusception 13 .…”