African Journal of Paediatric Surgery About APSON | PAPSA  
Home About us Editorial Board Current issue Search Archives Ahead Of Print Subscribe Instructions Submission Contact Login 
Users Online: 1292Print this page  Email this page Bookmark this page Small font size Default font size Increase font size 
 
 


 
CASE REPORT Table of Contents   
Year : 2014  |  Volume : 11  |  Issue : 3  |  Page : 261-263
A child with colo-colonic intussusception due to a large colonic polyp: Case report and literature review


1 Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
2 Department of Pathology, Juntendo University School of Medicine, Tokyo, Japan

Click here for correspondence address and email

Date of Web Publication22-Jul-2014
 

   Abstract 

Colo-colonic intussusception (CI) due to a colonic polyp is a rarely reported cause of intestinal obstruction in school-aged children. Hydrostatic reduction (HR) and endoscopic polypectomy are minimally invasive and technically feasible for treating CI. We report a case of CI and review the literature, focusing on the diagnosis and treatment.

Keywords: Children, colo-colonic intussusception, colonic polyp, intestinal obstruction

How to cite this article:
Takahashi T, Miyano G, Kayano H, Lane GJ, Arakawa A, Yamataka A. A child with colo-colonic intussusception due to a large colonic polyp: Case report and literature review. Afr J Paediatr Surg 2014;11:261-3

How to cite this URL:
Takahashi T, Miyano G, Kayano H, Lane GJ, Arakawa A, Yamataka A. A child with colo-colonic intussusception due to a large colonic polyp: Case report and literature review. Afr J Paediatr Surg [serial online] 2014 [cited 2022 Nov 28];11:261-3. Available from: https://www.afrjpaedsurg.org/text.asp?2014/11/3/261/137338

   Introduction Top


Intestinal intussusception is the most common abdominal emergency in early childhood. [1] At our institution, a paediatric surgical team performs hydrostatic reduction (HR) according to a standardised protocol with excellent results. [2],[3] However, colo-colonic intussusception (CI) is an uncommon cause of intestinal obstruction in children and because it is sometimes not easily diagnosed, [4],[5] treatment can be delayed, resulting in more radical surgical intervention, such as a bowel resection, [6] being required.

Here, we report a case of CI due to a large colonic polyp presenting with intestinal obstruction in a 10-year-old girl, reduced successfully using HR and treated safely with endoscopic surgery.


   Case Report Top


A 10-year-old girl was referred with a diagnosis of acute intestinal obstruction following a history of abdominal pain and bloody stools for almost 24 h. A target sign was identified on computed tomography, suggestive of CI [Figure 1]. At the time of admission, her body temperature was 36.4°C, heart rate was 62 beats/min, respiratory rate was 25 breaths/min, and blood pressure was 112/66 mmHg. Her abdomen was slightly distended and a palpable mass was present in the left lower abdomen without signs of peritoneal irritation.
Figure 1: A target sign was identifi ed on computed tomography, suggestive of colo-colonic intussusception

Click here to view


After a meniscus sign was observed, HR was attempted according to our standardised protocol [3] [Figure 2]. The CI was reduced successfully after two trials of HR. At the first trial, a water-soluble contrast agent (Gastrograffin ® diluted 1:5) was to be introduced gradually at a pressure of 60 cm H 2 O and the position of the tip reduced from the lower sigmoid colon to the middle part of the descending colon. At the second trial, CI was successfully reduced with an enema pressure of 80 cm H 2 O.
Figure 2: Hydrostatic reduction (HR) was attempted after a meniscus sign was observed. Colo-colonic intussusception was reduced successfully. After two trials of HR performed according to our standardised protocol

Click here to view


One week later, after malnutrition and intestinal oedema both improved, elective colonoscopy was performed. A large pedunculated polyp, measuring 3 cm in diameter, was identified in the transverse colon and hot snare polypectomy was performed successfully after the vascular supply was controlled using two hemoclips [Figure 3]. Three other small polyps in the descending and sigmoid colon were also removed successfully. Histopathology identified that all polyps were juvenile polyps [Figure 4]. Post-operative recovery was uneventful, and our case is well, 1 year after surgery.
Figure 3: (a) A large pedunculated polyp, measuring 3 cm in diameter in the transverse colon. (b) The vascular supply of the big polyp controlled with two hemoclips. (c) Successful hot snare polypectomy

Click here to view
Figure 4: Low-power view of a specimen from the polypoid lesion with multiple dilated glands typical of hamartomatous change (H and E, ×12.5)

Click here to view



   Discussion Top


Colo-colonic intussusception is an uncommon cause of intestinal obstruction in children. The most common type of intussusception is idiopathic ileocolic, [7],[8],[9] associated with a pathologic lead point (PLP) in only 5% of cases; although the incidence of PLP increases with age and number of episodes. [4],[10] The most common PLP is Meckel's diverticulum, followed by small bowel polyps and intestinal duplication. [5],[8] Intussusception not involving the ileocolic junction appears to have a higher incidence of PLP and requires surgical intervention such as a bowel resection. [7]

Treating intussusception associated with a PLP is essentially the same as treating idiopathic intussusception, involving a trial of careful reduction using a minimally invasive approach; but diagnosis can sometimes be delayed in PLP cases if only standard diagnostic procedures such as history of presentation, physical examination, and plain abdominal radiography are used. Review of literature suggests that intussusceptions caused by colonic polyps or other mass lesions can rarely be reduced by hydrostatic barium enema and these patients often require laparotomy. [11],[12] Thus, HR is a useful initial treatment for CI due to a colonic polyp unless the patient has signs of peritonitis due to bowel perforation.

Once CI is reduced, colonoscopy is indicated in order to identify the PLP in the colon. In our case, elective colonoscopy was performed 1 week later with successful hot snare polypectomy of a large 3 cm pedunculated polyp arising in the transverse colon.

Juvenile polyps usually occur in the first decade of life. The usual presenting symptom is painless bleeding. Although a solitary lesion is often benign, malignant transformation can occur in juvenile polyposis syndrome when the number of juvenile polyps is >5. [13] Thorough endoscopic examination of the entire colon is important for distinguishing juvenile polyposis syndrome from a solitary polyp.

To the best of our knowledge, there are only five reports involving six cases of CI secondary to a colonic polyp in a child over 7 years old in the literature [Table 1]. Mean age at diagnosis was 9.5 years (range: 7-11 years). Male to female ratio was 2:4. The location of the polyp was left transverse colon in five cases, and descending colon in one case. In cases 2 and 5, CI was reduced using Hutchinson's technique, and in cases 3 and 4, reduction occurred spontaneously during sonography. In case 1 and our case, CI was reduced using HR. In four cases (including our case), endoscopic polypectomy was performed successfully. In cases 1 and 2, transabdominal colotomy and polypectomy were performed. All cases except for ours require the laparotomy for reduction of intussusception or polypectomy.
Table 1: Colo-colonic intussusception secondary to a colonic polyp in children over 7 years old

Click here to view
[17]


   Conclusion Top


Colo-colonic intussusception in a school-aged patient is rare and usually associated with a PLP. The primary goal of treatment is reduction after careful assessment to identify a PLP. HR and endoscopic polypectomy are minimally invasive and technically feasible for the surgical treatment of CI due to a colonic polyp.

 
   References Top

1.West KW, Stephens B, Vane DW, Grosfeld JL. Intussusception: Current management in infants and children. Surgery 1987;102:704-10.  Back to cited text no. 1
    
2.Takahashi T, Okazaki T, Watayo H, Ogasawara Y, Nakazawa N, Kato Y, et al. Radiographic signs predictive of success of hydrostatic reduction of intussusception. Pediatr Surg Int 2009;25:977-80.  Back to cited text no. 2
    
3.Okazaki T, Ogasawara Y, Nakazawa N, Kobayashi H, Kato Y, Lane GJ, et al. Reduction of intussusception in infants by a pediatric surgical team: Improvement in safety and outcome. Pediatr Surg Int 2006;22:897-900.  Back to cited text no. 3
    
4.Applegate KE. Intussusception in children: Evidence-based diagnosis and treatment. Pediatr Radiol 2009;39 Suppl 2:S140-3.  Back to cited text no. 4
[PUBMED]    
5.Chung JL, Kong MS, Lin JN, Wang KL, Lou CC, Wong HF. Intussusception in infants and children: Risk factors leading to surgical reduction. J Formos Med Assoc 1994;93:481-5.  Back to cited text no. 5
    
6.Humphry A, Ein SH, Mok PM. Perforation of the intussuscepted colon. AJR Am J Roentgenol 1981;137:1135-8.  Back to cited text no. 6
[PUBMED]    
7.Chua JH, Chui CH, Jacobsen AS. Role of surgery in the era of highly successful air enema reduction of intussusception. Asian J Surg 2006;29:267-73.  Back to cited text no. 7
    
8.Waseem M, Rosenberg HK. Intussusception. Pediatr Emerg Care 2008;24:793-800.  Back to cited text no. 8
    
9.Grant HW, Buccimazza I, Hadley GP. A comparison of colo-colic and ileo-colic intussusception. J Pediatr Surg 1996;31:1607-10.  Back to cited text no. 9
    
10.Soccorso G, Puls F, Richards C, Pringle H, Nour S. A ganglioneuroma of the sigmoid colon presenting as leading point of intussusception in a child: A case report. J Pediatr Surg 2009;44:e17-20.  Back to cited text no. 10
    
11.Ein SH. Leading points in childhood intussusception. J Pediatr Surg 1976;11:209-11.  Back to cited text no. 11
[PUBMED]    
12.Puri P, Guiney EJ. Small bowel tumours causing intussusception in childhood. Br J Surg 1985;72:493-4.  Back to cited text no. 12
[PUBMED]    
13.Haghi Ashtiani MT, Monajemzadeh M, Motamed F, Moradi Tabriz H, Mahjoub F, Karamian H, et al. Colorectal polyps: A clinical, endoscopic and pathologic study in Iranian children. Med Princ Pract 2009;18:53-6.  Back to cited text no. 13
    
14.Ippolito RJ, Touloukian RJ. Colocolic intussusception in an older child. Caused by a polyp of the distal colon. Clin Pediatr (Phila) 1978;17:720-1, 726.  Back to cited text no. 14
[PUBMED]    
15.Gryboski JD, Barwick KW. Juvenile polyps and ulcerative colitis. J Pediatr Gastroenterol Nutr 1987;6:811-4.  Back to cited text no. 15
    
16.Baldisserotto M, Spolidoro JV, Bahú Mda G. Graded compression sonography of the colon in the diagnosis of polyps in pediatric patients. AJR Am J Roentgenol 2002;179:201-5.  Back to cited text no. 16
    
17.Suksamanapun N, Uiprasertkul M, Ruangtrakool R, Akaraviputh T. Endoscopic treatment of a large colonic polyp as a cause of colocolonic intussusception in a child. World J Gastrointest Endosc 2010;2:268-70.  Back to cited text no. 17
    

Top
Correspondence Address:
Dr. Toshiaki Takahashi
Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421
Japan
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0189-6725.137338

Rights and Permissions


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1]

This article has been cited by
1 Endoscopic polypectomy of a large juvenile polyp due to recurrent intussusception in a 3-year-old child with severe anemia
Hsien-Yi Lin, Yu-Wei Fu, Wei-Hao Wang, Fang-Ting Lu
Pediatrics & Neonatology. 2022;
[Pubmed] | [DOI]
2 Development and Validation of a Nomogram for Predicting Pathological Intussusceptions in Children Prior to Surgical Intervention
Xu Ting, Duan Xufei, Liu Jiangbin, Xu Weijue, Lv Zhibao, Ye Guogang
Frontiers in Pediatrics. 2022; 10
[Pubmed] | [DOI]
3 Colocolic Intussusception in Children: A Case Series and Review of the Literature
Jiayu Yan, Qiulong Shen, Chunhui Peng, Wenbo Pang, Yajun Chen
Frontiers in Surgery. 2022; 9
[Pubmed] | [DOI]
4 Recurrent Recto-Sigmoid Intussusception due to Juvenile Polyp: A Case Report
Sevim Ecem Ünlü Balli, Gökhan Berktug Bahadir, Mehmet Bahadir Çaliskan, Hüseyin Emre Atasever, Gülenay Korkmaz, Ilhami Sürer, Suzi Demirbag
Journal of Ankara University Faculty of Medicine. 2022; 75(2): 315
[Pubmed] | [DOI]
5 Successful colonoscopic decompression of colocolic intussusception with polypectomy in a five-year-old
Omar El-Ghazzawy, Ellen M. Encisco, Reinaldo Garcia-Naveiro, Justin T. Huntington
Journal of Pediatric Surgery Case Reports. 2021; : 102146
[Pubmed] | [DOI]
6 The diagnosis and treatment of retrograde intussusception: a single-centre experience
Bing Zhang, Dianming Wu, Mingkun Liu, Jianxi Bai, Fei Chen, Rong Zhang, Yifan Fang
BMC Surgery. 2021; 21(1)
[Pubmed] | [DOI]
7 Diagnostic Value of Ultrasound-Guided Water Enema for Secondary Intussusception in Children
Hu, MD Liezhen, Xia, MD Bei, Ma, MD Xiaopeng, Liu, MD Tingting, Ding, MD Tingting, Xiao, MD Dong, Wang, MD Bin, Yu, MD Wei, Lin, MD Zhou, Liu, MD Lei, Feng, MD Xia
ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY. 2020; 4(3): 204
[Pubmed] | [DOI]
8 Intussusception: It’s Not Always Ileo-Colic
Shabana Rasheed, Thida Win, Marielle V Fortier
Annals of the Academy of Medicine, Singapore. 2019; 48(6): 195
[Pubmed] | [DOI]
9 Large juvenile colonic polyp presenting as colocolic intussusception in a child
Vladimír Mihál, TomᚠMalı, Jana Janková, Kamila Michálková
Pediatrie pro praxi. 2017; 18(6): 379
[Pubmed] | [DOI]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Email Alert *
    Add to My List *
* Registration required (free)  
 


    Abstract
   Introduction
   Case Report
   Discussion
   Conclusion
    References
    Article Figures
    Article Tables

 Article Access Statistics
    Viewed4524    
    Printed103    
    Emailed0    
    PDF Downloaded215    
    Comments [Add]    
    Cited by others 9    

Recommend this journal