Delayed diagnosis of transanal prolapse of an ileo-colic intussusception in a 10-month-old infant in rural Cameroon: a case report

Abstract

BackgroundTransanal protrusion of intussusception is a complication of intussusception which involves the exteriorization of the apex of the intussusceptum through the anus. However, it is rarely reported and its confusion with rectal prolapse often leads to a diagnostic delay.Case presentationA 10-month-old female with no significant past history from a rural area in the Extreme North region of Cameroon was referred from a local health centre to our emergency deparment for an irreducible mass. It was reported that the child had spent 5 days at home on over-the-counter medication, then 3 days at a health centre where she was being treated for a respiratory tract infection and a rectal prolapse. On arrival at our hospital, she was conscious and moderately dehydrated. Cardiopulmonary examination revealed generalized coarse crackles over both lung fields. Her abdomen was tender, with a left upper quadrant mass, absent bowel sounds and a dark anal mass. In view of these, diagnoses of bronchopneumonia, intestinal obstruction and a probable rectal prolapse were made. An exploratory laparotomy was carried out after resuscitation with per-operative findings of a prolapsed ileo- colic intussusception and a necrosed intussusceptum. The necrosed portion was resected and an end-to-end ileo-transverse anastomosis was carried out. The immediate post- operative period was uneventful, but the patient died 3 days after the surgery, from an overwhelming sepsis.ConclusionsTransanal protrusion of intussusception requires timely surgical intervention to prevent mortality. The similarity in presentation to rectal prolapse coupled with inadequate knowledge on the condition by primary healthcare personnel causes a delay in the diagnosis and an increased mortality. A high index of suspicion is essential for an early diagnosis and an improved referral system for timely and definitive treatment.

Delays in presentation of intussusception and development of gangrene in Zimbabwe

“…It may also protect the bowel from the development of gangrene. Furthermore, rectal protrusion of intussusception has been thought to represent an excessive delay in presentation [ 44 , 45 ], but equally could reflect excessive laxity of the mesentery of normally fixed retroperitoneal structures [ 46 ]. One patient from Nigeria with rectal protrusion reported presented after 28 days and had no gangrene or perforation [ 47 ].…”

The Prolapsed Intussusceptum in a 4-month-old Male: A Case Report

“…Additionally, it has a female predisposi-tion, contrary to other intussusceptions (3). It requires prompt diagnosis and management to prevent morbidity and mortality (4). A tabular presentation of various reports in the literature is listed in Table 1.…”

Profile of Children Treated for Uncomplicated Intussusception in a Tertiary Hospital in Enugu, Nigeria

“…However, classically, the symptoms of intussusception include abdominal pain, vomiting and passage of red currant jelly stool [3]. However, these classical symptoms are found only in about 20 percent of the patients [4]. Abdominal ultrasound is diagnostic imaging of choice for the diagnosis of intussusception due to its high sensitivity and specificity [5].…”