One of the most common abdominal emergencies in children is intussusception. It frequently occurs near the ileocecal junction and rarely involves only the colon. Approximately 90% of ileocolic intussusception cases are idiopathic, and the majority can be resolved nonsurgically with a therapeutic enema. Almost all colocolonic intussusception, however, is caused by pathologic lead points and requires surgical intervention, such as colonoscopic polypectomy, open surgery, or laparoscopic surgery. Juvenile polyps are the most common cause of colocolonic intussusception.
The available literature on colocolonic intussusception is limited and primarily consists of case reports. Although some case reports have shown that a successful therapeutic enema followed by colonoscopic polypectomy can be used to treat colocolonic intussusception caused by a juvenile polyp, open surgery is still used in the majority of cases. Furthermore, the effect of laparoscopic surgery on colocolonic intussusception in children is debatable, and it is frequently used for surgical exploration, and the treatment of colocolonic intussusception caused by other lead points is unknown.
A 5-year-old boy with no significant medical history was brought to the surgery clinic after experiencing intermittent abdominal pain and mucus-covered stool for two days. Physical examination revealed pain in the periumbilical region but no rebound or guarding. Abdominal ultrasonography revealed no abnormalities. Computed tomography of the abdomen was performed due to the patient’s ongoing severe pain, which revealed a target sign (Panel A, asterisk; transverse view) and telescoping (Panel B, asterisk; sagittal view) in the descending colon.
Based on these findings, doctors diagnosed the patient with colocolonic intussusception. Colonic intussusception is a relatively uncommon cause of intestinal obstruction in children, with the majority of cases being ileocolic rather than colocolonic. In the majority of cases, a pathologic lead point, typically a juvenile polyp, is present. The patient’s symptoms went away after a pneumatic reduction. Following the procedure, an abdominal radiograph revealed a polypoid mass in the left upper quadrant (Panel C). A subsequent colonoscopy revealed a 2.5-cm pedunculated polyp, which was thought to be the source of the intussusception (Panel D). The polyp was resected, and histopathological examination showed it to be a hamartoma. The patient’s symptoms had not returned after a 2-month follow-up visit.
In infants and children, both intussusception and malrotation are common
The link between them was first reported by George E Waugh in 1911, and authors have continued to refer to it as “Waugh’s syndrome”. This association, however, is rarely reported in the literature. The most common type of intussusception in children is ileocolic intussusception, which accounts for 95% of cases. Colocolic intussusceptions are typically seen in adults, often in conjunction with pre-existing colonic pathology that serves as a tipping point. They are extremely rare in the paediatric population, and no studies have been conducted to determine the disease’s exact prevalence.
Similarly, in all reported cases of Waugh’ syndrome, the intussusception is of the ileocolic variety, with the exception of one report of colocolonic variety in which lymphangioma was the Pathological Lead Point (PLP). Again, 95% of intussusceptions in children are idiopathic and have no pathologic cause. Only a few patients have PLP, with Meckel’s diverticulum being the most common finding. Our case is extremely rare because it was a colocolonic intussusception in a seven-year-old child in which the transverse colon with a large polyp as PLP invaginated into the descending and sigmoid colons, as well as malrotation. All of these unusual discoveries prompted us to conduct an extensive literature search. In children, colocolonic intussusception with juvenile polyp as PLP has been reported.
Intussusception can coexist with intestinal malrotation. If the obstruction persists after the intussusception has been reduced, an associated malrotation may be misdiagnosed as recurrent intussusception. When operating on a child with colocolonic intussusception, PLP should be looked for. Waugh’s syndrome should be considered during both surgical and non-surgical management of intussusception.