Intussusception In Adolescence: A Rare Entity

Backgroung: Intussusception is a common cause of intestinal obstruction between 3 months and 6 years of age, being unusual in adolescence with an atypical presentation in most cases. The clinical suspicion is important at every age, since delayed diagnosis may lead to intestinal ischemia.

Case: A healthy 16-year-old male presented to the emergency department with lower right abdominal pain and vomiting with onset 12 hours previously. No fever, diarrhea or other symptoms. No history of recurrent infections. His cousin was diagnosed with acute gastroenteritis. At physical examination, he had abdominal pain in the right iliac fossa and pain at decompression. Abdominal ultrasound showed an image that suggested a small bowel intussusception with 4,9 cm of extension. Blood tests were normal. He was admitted with conservative treatment. Stool culture was negative for bacteria or viruses. The intussusception was reduced spontaneously (confirmed by ultrasound) and he was discharged the day after. He presented to the emergency department one week later with abdominal pain. The ultrasound was repeated and showed a recurrence of the intussusception. The abdominal and pelvic CT was normal. He was again admitted and kept under surveillance. The intussusception reduced spontaneously in 24 hours. The investigation was negative for intestinal parasitosis, celiac disease, Meckel’s diverticulum and the video capsule endoscopy showed no alterations of the intestinal mucosa. Idiopathic intussusception of the small bowel was the final diagnosis.

Conclusion: Intussusception is idiopathic in most cases, however, in older children, it usually has an underlying cause. It is typically related to pathological lead points such as Meckel’s diverticulum, lymphoid hyperplasia, intestinal polyps or intestinal lymphoma. This report of a case of intussusception at an unusual age emphasizes the importance of investigating and excluding secondary causes, in order to implement an appropriate treatment.