Adedayo Adebayo Ayokunle, Ekpenukpang Ola Matthias, Ahmed Munir Nadani, Ameh Emmanuel Adoyi
Department of Surgery, Nigerian Navy Reference Hospital, Calabar, Cross Rivers State, Nigeria.
Department of Pathology, University of Calabar Teaching Hospital, Calabar, Cross Rivers State, Nigeria.
Ann Afr Med. 2025 Jul 1;24(3):681-685. doi: 10.4103/aam.aam_100_24. Epub 2025 May 30.
Intussusception in children may present in typical or atypical manner. These presentations sometimes typify the background etiopathophysiology. It may be primary (idiopathic) or secondary in origin depending on the presence or absence of an identifiable pathologic lead point (PLP). The idiopathic category is seen in 90% of intussusception cases in children. The secondary categories have varying pathological lead points, with some still unreported. This report narrates our experience in the management of a 6-year-old child with a colocolic megacolon intussusception. It was characterized by a subtle history of chronic constipation and solid diet intolerance. Long-standing colicky abdominal pain was interpreted as a food allergy, and this was a critical clinical miss. Radiographical megacolon appearance on X-ray was misinterpreted as a dilated gastric shadow. Ultrasound evaluation was diagnostic, but this could not distinguish the PLP. Surgical intervention was planned for ileocolic intussusception; however, a colocolic intussusception was encountered, and an inappropriate intraoperative decision to perform a pry colo-colonic anastomosis was taken. Atypical septic-induced persistent bradycardia and severe lethargy were danger signs of anastomotic leakage that necessitated a re-exploration laparotomy and a lifesaving diverting colostomy. A definitive Duhamel pull-through procedure was carried out after 11 months of optimization. Management was challenging and required an aggressive and proactive approach. We recommend a high index of suspicion in making a diagnosis and a diverting colostomy in the emergency surgical intervention for all secondary colo-colic megacolon intussusception.
小儿肠套叠可能以典型或非典型方式呈现。这些表现有时体现了潜在的病因病理生理学。根据是否存在可识别的病理性引导点（PLP），其可能为原发性（特发性）或继发性。特发性类别见于90%的小儿肠套叠病例。继发性类别有不同的病理性引导点，有些仍未被报道。本报告讲述了我们对一名患有结肠结肠型巨结肠肠套叠的6岁儿童的治疗经验。其特点是有慢性便秘和不耐固体食物的隐匿病史。长期的绞痛性腹痛被误诊为食物过敏，这是一个严重的临床失误。X线片上的巨结肠表现被误判为扩张的胃影。超声评估具有诊断价值，但无法区分病理性引导点。原计划对回结肠型肠套叠进行手术干预；然而，术中发现是结肠结肠型肠套叠，并做出了不恰当的术中决定，即进行结肠结肠吻合术。非典型的败血症诱发的持续性心动过缓和严重嗜睡是吻合口漏的危险信号，这使得有必要再次进行剖腹探查并实施挽救生命的转流性结肠造口术。在经过11个月的优化后进行了确定性的杜哈梅尔拖出术。治疗具有挑战性，需要积极主动的方法。我们建议在诊断时保持高度怀疑，并对所有继发性结肠结肠型巨结肠肠套叠在急诊手术干预时实施转流性结肠造口术。
