Perinatal intussusception in premature infants

Intussusception is common in infants aged 5 to 18 months, but there have been only 12 reports of its occurrence among premature infants. Nine of these previously reported cases with adequate data and one new case are reviewed. Many of the infants were believed to have necrotizing enterocolitis, leading to an average 12-day interval between the onset of signs and the operation. Bilious emesis or nasogastric contents, bloody stool, and intestinal dilation without pneumatosis intestinalis were common. A contrast enema showed the intussusception in only 1 of 7 cases. Most cases were diagnosed in the operating room and underwent successful primary anastomosis, with no recurrences. A pathological lead point was identified in 2 of the 10 cases. The overall mortality rate was 23%; the one death since 1970 was secondary to attempted hydrostatic reduction. These cases may represent what, in the absence of premature delivery, would have been the intrauterine development of intussusception likely leading to small bowel atresia.

Postnatal intussusception in a premature infant, causing jejunal atresia

The authors report on a 5-week-old boy who presented with bilious gastric aspirates. He became intolerant to feedings after 1 week of adequate feeding and passage of stools. Based on clinical and radiological findings, the diagnosis of intestinal obstruction was made. During laparotomy, atresia of the proximal jejunum was found. The lumen of the distal segment contained an intussusceptum. The blind ends were resected, and end-to-end anastomosis was performed.

Delayed presentation of intestinal atresia and intussusception--a case report and literature review

Neonatal intussusception is a rare phenomenon. We report a case where intestinal obstruction became evident after eight days in an infant of 32 weeks gestational age and 0.94 kg birth weight. Laparotomy revealed a type 2 ileal atresia, present as a result of ischaemic injury secondary to intra-uterine intussusception. Resection of the intussuscepted segment was carried out with primary anastomotic repair leading to a good outcome. A period of eight days passed before clinically evident abdominal distension was noted. We address reasons why this may have occurred.

Intrauterine intussusception causing intestinal atresia

The patient presented at the age of 2 days with persistent bilious vomiting, failure to pass meconium and urine, and progressive abdominal distension dating from birth, and a clinical diagnosis of intestinal obstruction was made. This was confirmed by plain abdominal radiographs. At laparotomy atresia of the terminal ileum was found. The proximal and distal segments of the bowel ended blindly and there was a V-shaped defect in the adjoining mesentery. The blind ends were resected and an end-to-back anastomosis was performed. The lumen of the resected distal segment contained an intussusceptum.

Cecal duplications: a rare cause for secondary intussusception

Duplications of the alimentary tract are rare congenital anomalies that may occur at any level from mouth to anus. While the oesophagus and the ileum are the most common sites, duplications of the colon are rare. Two cases of ileocolic intussusceptions in 8-month-old girl and 6-month-old boy who were admitted to our hospital with acute abdomen findings are presented. Intraoperatively, cecal cystic duplications leading intussusception were revealed. Intussusception is one of the most important surgical emergence in infancy and typically, it does not involve a lead point in childhood. Although duplication cyst may act as lead point, the review of literature reveals its rarity.

Intrauterine intussusception and ileal atresia presenting as acute perforation

A case is reported of a girl born by caesarean section at 28 weeks gestation who developed an acute perforation of the ileum due to intussuspetion 11 days after birth. This was treated successfully by resection of the affected segment of ileum and by performing a temporary ileostomy followed by end-to-end anastomosis. She made a complete recovery. This case also demonstrates the difficulty of early diagnosis of intussusception in the neonatal period.

Meckel's Diverticulum Induced Intrauterine Intussusception Associated with Ileal Atresia Complicated by Meconium Peritonitis

Intrauterine intussusception with a leading point of Meckel's diverticulum is a rare cause of ileal atresia, which may cause bowel obstruction and perforation. We report such a case complicated by meconium peritonitis. The fetal ultrasonogram revealed ascites, dilated bowel loops and intra-abdominal calcification at a gestational age of 30 weeks. The patient was delivered at 37 weeks and laparotomy was performed to manage the intestinal obstruction. The operative findings showed that Meckel's diverticulum had induced intussusception associated with the ileal atresia with meconium peritonitis. The ileum was resected with end-to-end anastomosis. The postoperative course was uneventful. In this patient, ascites and intraperitoneal calcification were caused by ileal atresia, which may have been induced by intrauterine intussusception.

A Case of Congenital Infantile Fibrosarcoma of the Bowel Presenting as a Neonatal Intussusception

Neonatal intussusception of the intestinal tract is rare. However, most neonatal intussusceptions have an organic lead point. For the lead point to be a neoplasm is extremely rare. We report a case that presented with neonatal intussusception with a congenital infantile fibrosarcoma as the lead point. The detection of ETV6-NTRK3 gene fusion was useful, although the definitive diagnosis was achieved by a comprehensive evaluation including this gene analysis, standard histology and immunohistochemistry. Neonatal intussusception should be suspected to be caused by a neoplasm. If pathological diagnosis is difficult, molecular analysis should be utilized to diagnose congenital infantile fibrosarcoma.

Intussusception and duodenal stenosis: an infrequent but expected association

Two boys with intussusception, intestinal malrotation and duodenal stenosis are reported. Because intussusception is associated with malrotation, which is in turn associated with duodenal stenosis, this combination of abnormalities may be expected in up to 3% of children with intussusception.

MIRAGE Syndrome Caused by a De Novo c.3406G>C (p. Glu1136Gln) Mutation in the SAMD9 Gene Presenting With Neonatal Adrenal Insufficiency and Recurrent Intussusception: A Case Report

INTRODUCTION

Primary adrenal insufficiency (PAI) presenting in the neonatal period can be life threatening and requires early recognition, diagnosis, and management. PAI due to adrenal hypoplasia (syndromic/non-syndromic) is a rare disorder. MIRAGE is a recently described syndrome with PAI and multisystem involvement.

CASE PRESENTATION

A preterm female neonate presenting with PAI and persistent severe thrombocytopenia was diagnosed to have MIRAGE syndrome due to a de novo pathogenic variant c.3406G>C (p. Glu1136Gln) in the SAMD9 gene. In the first year of life, she had recurrent respiratory and gastrointestinal infection causing failure to thrive. At 17 months, she suffered recurrent intussusception requiring treatment with parenteral nutrition and high-dose steroids. Subsequently, she established oral feeds with hydrolysed formula and demonstrated good weight gain.

CONCLUSION

In neonates presenting with PAI and associated multisystem involvement, a thoughtful approach and genetic testing is valuable in discerning an etiological diagnosis. This case of MIRAGE adds to the spectrum of reported cases and is the first to report on recurrent intussusception and its management with high-dose steroids.

[Surgical therapy of malrotations in childhood]

From a total of 174 children treated with malrotations from 1971 to 1988, 148 could be evaluated for long-term results of surgical treatment. The various modalities of treatment were: no correction, dissection of Ladd's bands only, caecoascendopexy, Ladd's procedure and the so-called total correction. Comparing the late results in children with and without correction it was found that those without correction, i.e. without pexy, had to be reoperated in 17% of the cases, whereas the totally corrected children required reoperation in 8% of the cases only. Corrected cases needed to be admitted but not operated later because of pain, constipation, vomiting or poor weight gain in 23%, the uncorrected ones in 6%. Likewise, corrected malrotations resulted in complaints in 27% in contrast to the noncorrected ones in 9%. The conclusion is that total correction results in fewer reoperations but in more symptoms not requiring surgery.

Myoepithelial hamartoma of the ileum causing intussusception in an infant

Intussusception is a relatively common pediatric gastrointestinal emergency, although the etiology in most cases remains unknown. In a small number of cases the lead point is a tumor or tumor-like lesion of the small bowel. We report an unusual case of a myoepithelial hamartoma of the ileum causing an intussusception in a 4-month-old boy. This is the second such report in the literature.

Jejunal atresia secondary to intrauterine intussusception, presenting as acute perforation

Intussusception in neonates is rare. The authors report the second case in the Western literature of neonatal intussusception presenting as pneumoperitoneum. A male infant was referred 30 hours after birth because of possible midgut volvulus after emesis and failure to pass meconium. An abdominal x-ray film revealed a large amount of free air in the peritoneal cavity. At operation a type 3 jejunal atresia was found, with a 2-mm perforation in the dilated proximal end and a viable intussusceptum just inside the distal end. The authors conclude that this case represents an atresia secondary to inutero intussusception, with perforation occurring after birth (secondary to air-swallowing and gastrointestinal secretions).

Tracheal left mainstem bronchus and obstructive gastric mucosal intussusception associated with esophageal atresia

A tracheal left mainstem bronchus and gastric outlet obstruction owing to gastric mucosal intussusception occurred in a child who had esophageal atresia and tracheoesophageal fistula. Bronchography and bronchoscopy, indicated because of persisting atelectasis and ventilation dependency, showed a tracheal left mainstem bronchus. The atelectasis disappeared after reimplantation of the left mainstem bronchus into the carina. Feeding problems and recurrent pulmonary infections complicated the postoperative course. Radiographic imaging and esophagogastroscopy showed severe reflux esophagitis and a prepyloric mass that consisted of a gastric mucosal intussusception. Subsequent gastrotomy and resection of the intussuscepted mucosal fold relieved the gastric outlet obstruction. An antireflux procedure was performed simultaneously. The child recovered satisfactorily. It is suggested that gastric mucosal intussusception may be associated with esophageal atresia rather than with the presence of a gastrostomy tube, as has been proposed in the literature.

[Prenatal intestinal invagination. Presentation of a case and review of the literature]

We report a case of intrauterine intussusception in a female newborn. Despite the absence of intestinal atresia or any sign of ischemic necrosis, the manual reduction of the intussusception was impossible because of the multiple adhesions developed in the prenatal period. Laparotomy was done at the age of 10 days, the lesion was resected and end-to-end anastomosis was performed. The postoperative course was uneventful.

[Intrauterine invagination in a newborn infant]

Intussusception in neonates is rare. We present a case of neonatal intrauterine intussusception, which was treated by partial colectomy. Differences between neonatal and infantile intussusception are detailed. Because of the advanced clinical signs of intestinal obstruction and the increased risk of perforation when hydrostatic reduction is performed, operative reduction and/or resection is recommended.

Intrauterine intussusception: case report and literature review

Intussusception in the newborn is a unique clinical entity, and one of the most unusual causes of intestinal obstruction in infants. Its cause can be idiopathic, secondary to a local lesion or a complication of disease. Early diagnosis and treatment are important, because survival depends on them. The authors report a case of jejunal atresia secondary to intrauterine intussusception, followed by a literature review. Less than 30 cases have been adequately documented in the world literature. Eight reports from the literature are selected to highlight clues for early diagnosis, such as vomiting, with or without bile, abdominal distension and bloody stools, because of their prognostic implications. Intussusception is rare under the age of 3 months; the incidence is 0.3% in the neonatal period. Previous reports indicate that a confusing clinical picture has led to a delay in operation and a high mortality. The ultimate outcome depends on an acute awareness of the condition in the presence of the diagnostic clues in a newborn.

Jejunal atresia in a neonate due to intrauterine intussusception

We report a female neonate, who presented with abdominal distension and failure to pass meconium. Antenatal ultrasound at 32 weeks gestation and postnatal ultrasound on day1 suggested intestinal obstruction. During laparatomy, atresia of distal jejunum was found. The lumen of the distal segment contained an intussusceptum. Resection of the blind ends was done and end-to-end anastomosis was performed.

Neonatal ileocolic intussusception with enterogenous cyst: ultrasonic diagnosis

An eight-day-old girl had sonography performed to rule out pyloric stenosis because of recurrent vomiting and a right upper quadrant mass. Caudal to the normal pylorus sonography demonstrated an elongated mass containing two hypoechoic rings with a cyst at the end of it. An ileocolic intussusception was then diagnosed by a barium examination. Surgery confirmed the diagnosis, the leading mass being a duplication cyst.

Histological study of intestinal atresia due to intrauterine intussusception

Histological studies were conducted on 4 patients with intestinal atresia due to intrauterine intussusception. This atresia is characterized by a polypoid lesion as the remnant of the invaginated and necrotized intestine in the distal intestinal lumen. As the result of the histological survey in the affected intestine, we tentatively classified this atresia into two types, type A and B. In type A, the polypoid lesion is observed at the blind end, with relatively good preservation of the structure of the intestine. In type B, the polypoid lesion is located apart from the blind end, and the lesion is markedly necrotic. The interruption of intestinal blood flow seemed to be more severe in type B than in type A.