Chronic Ileocecal Intussusception Secondary to Non-Hodgkins Lymphoma

Abstract

Chronic intussusception is a distinct clinical entity which is unfortunately poorly recognized due to its atypical presentation. A 5½ year old female patient presented with a 5 month history of abdominal pain associated with occasional vomiting, anorexia and progressive weight loss. 5 days prior to admission she developed loose, non-mucoid, non-blood stained stool associated with refusal to feed and irritability. Systemic examination, an abdominal ultrasound and abdominal radiograph were non-contributory. During treatment for malnutrition and dehydration she was noted to clinically improve, however, 6 days post-admission she developed abdominal pain, a palpable sausage-shaped abdominal mass, and currant-jelly stool. Emergency laparotomy revealed an ileocecal intussusception with oedematous nonviable, aperistaltic terminal ileum and mobile cecum, a cecal mass and mesenteric lymphadenopathy was found. We performed a right hemicolectomy with an ileocolic anastomosis and mesenteric lymph node sampling. Histology results revealed the cecal mass as a lymphoproliferative neoplasm with a diagnostic consideration of intermediate to large cell Non-Hodgkins Lymphoma; and reactive hyperplasia of mesenteric lymph nodes. There is need for a high index of suspicion in children with non-specific abdominal symptoms for which no cause can be found. Further, all suspicious masses should have immunohistological histological evaluation.