Qumsieh Usama, Al-Ihribat Alaa R, Shawar Shahd B, Doudin Ahmed J M, Alhroub Omar A, Hajjaj Omar Y A
Palestine Polytechnic University, Faculty of Medicine, Hebron, Palestine; Pediatric Surgery Department, Al-Ahli Hospital, Hebron, Palestine.
Palestine Polytechnic University, Faculty of Medicine, Hebron, Palestine.
Int J Surg Case Rep. 2025 Jun 19;133:111548. doi: 10.1016/j.ijscr.2025.111548.
Intussusception in neonates is extremely rare, especially in full-term newborns. Even rarer is the occurrence of Meckel's diverticulum (MD) acting as a lead point within the first 24 h of life. Prompt recognition is critical as delays can lead to bowel perforation and life-threatening complications.
We report a case of a 13-hour-old full-term female neonate who presented with abdominal distension and signs of sepsis shortly after her first feed. Imaging revealed pneumoperitoneum, prompting emergent laparotomy. Intraoperatively, ileoileal intussusception with bowel perforation was identified, with Meckel's diverticulum acting as the lead point. The affected segment was resected with primary anastomosis. The patient required cardiopulmonary resuscitation intraoperatively but eventually made a full recovery after a second-look surgery and NICU support.
This case represents one of the earliest presentations of MD-related intussusception complicated by bowel perforation in a term neonate. Diagnosing intussusception in neonates is challenging due to atypical presentation. Although MD is the most common congenital GI anomaly, it rarely presents symptomatically in neonates, let alone as a cause of intussusception and perforation on day one of life.
Neonatal intussusception, particularly in term infants, should not be overlooked in the differential diagnosis of early abdominal emergencies. Meckel's diverticulum, despite its rarity as a lead point in this age group, must be considered to avoid delayed diagnosis and serious complications.
新生儿肠套叠极为罕见，尤其是足月儿。在出生后24小时内，梅克尔憩室（MD）作为肠套叠的起始点更为罕见。及时识别至关重要，因为延误可能导致肠穿孔和危及生命的并发症。
我们报告一例13小时大的足月儿女婴，首次喂奶后不久出现腹胀和败血症体征。影像学检查显示气腹，促使紧急剖腹手术。术中发现回肠-回肠型肠套叠伴肠穿孔，梅克尔憩室为起始点。切除受累肠段并进行一期吻合。患者术中需要心肺复苏，但在二次探查手术和新生儿重症监护病房（NICU）支持下最终完全康复。
该病例是足月新生儿中最早出现的与MD相关的肠套叠并伴有肠穿孔的病例之一。由于表现不典型，诊断新生儿肠套叠具有挑战性。尽管MD是最常见的先天性胃肠道异常，但在新生儿中很少有症状表现，更不用说在出生第一天就作为肠套叠和穿孔的原因了。
在早期腹部急症的鉴别诊断中，不应忽视新生儿肠套叠，尤其是足月儿。尽管梅克尔憩室作为该年龄组肠套叠起始点罕见，但必须考虑到以避免延迟诊断和严重并发症。
