Rainey Howard N, Ritter Jed T
Department of Emergency Medicine, Geisinger Medical Center, Danville, PA, USA.
Department of Emergency Medicine, Geisinger Medical Center, Danville, PA, USA.
Int J Surg Case Rep. 2025 Aug;133:111477. doi: 10.1016/j.ijscr.2025.111477. Epub 2025 Jun 6.
Intussusception is a rare, but serious cause of abdominal pain that must be considered in pediatric emergency medicine, especially in younger patients.
This report describes an 11-year-old male who presented to the emergency department (ED) with intermittent, waxing and waning abdominal pain, that later diagnosed as colo-colonic intussusception due to a colonic schwannoma lead point. Initial abdominal ultrasound revealed a complicated cystic at the descending colon. Follow-up computed tomography scan confirmed colo-colonic intussusception with a solid intra-luminal mass. Subsequent colonoscopy identified a five-centimeter broad based polypoid tumor at the splenic flexure which was non-resectable endoscopically. Left colon segmentectomy was performed removing six centimeters of bowel. Pathology diagnosed a benign colonic spindle schwannoma. Genetic screening was unremarkable, indicating a sporadic schwannoma that did not require additional surveillance or follow-up.
Pediatric intussusception most commonly presents in individuals three months to six years of age, making the above individual outside of the typical presenting age. In addition, the lead point in this case, colonic schwannoma is incredibly rare, particularly in the pediatric population. The patient also had a colo-colonic intussusception which is not the typical location of pediatric intussusceptions.
This case illustrates that, although most common in very young children, intussusception can occur at any age with the presence of a focal lead point and must remain on the differential diagnosis.
肠套叠是一种罕见但严重的腹痛病因，在儿科急诊医学中必须予以考虑，尤其是在年龄较小的患者中。
本报告描述了一名11岁男性，因间歇性、时轻时重的腹痛就诊于急诊科（ED），后来被诊断为因结肠神经鞘瘤致套叠点引起的结肠-结肠套叠。最初的腹部超声显示降结肠有一个复杂囊肿。后续的计算机断层扫描证实为结肠-结肠套叠，腔内有实性肿块。随后的结肠镜检查发现脾曲处有一个5厘米宽基底的息肉样肿瘤，内镜下无法切除。进行了左半结肠切除术，切除了6厘米肠段。病理诊断为良性结肠梭形神经鞘瘤。基因筛查无异常，表明是散发性神经鞘瘤，无需额外监测或随访。
小儿肠套叠最常见于3个月至6岁的儿童，上述病例患者超出了典型发病年龄。此外，该病例中的套叠点结肠神经鞘瘤极其罕见，尤其是在儿科人群中。该患者还发生了结肠-结肠套叠，这并非小儿肠套叠的典型部位。
该病例表明，尽管肠套叠在幼儿中最为常见，但在存在局灶性套叠点的情况下可发生于任何年龄，且必须保留在鉴别诊断范围内。
