Appendiceal Intussusception: A Diagnostic Challenge

Inbal Samuk; Adriana Nica; Yaniv Lakovski; Enrique Freud

doi:10.1055/s-0037-1604400

European Journal of Pediatric Surgery, Table of Contents

Eur J Pediatr Surg 2018; 28(01): 030-033
DOI: 10.1055/s-0037-1604400

Original Article

Georg Thieme Verlag KG Stuttgart · New York

Appendiceal Intussusception: A Diagnostic Challenge

Inbal Samuk

¹Department of Pediatric Surgery, Schneider Children's Medical Center of Israel, Sackler Faculty of Medicine, Tel Aviv University, Petah Tikva, Israel

,

Adriana Nica

¹Department of Pediatric Surgery, Schneider Children's Medical Center of Israel, Sackler Faculty of Medicine, Tel Aviv University, Petah Tikva, Israel

,

Yaniv Lakovski

²Department of Radiology, Schneider Children's Medical Center of Israel, Sackler Faculty of Medicine, Tel Aviv University, Petah Tikva, Israel

,

Enrique Freud

¹Department of Pediatric Surgery, Schneider Children's Medical Center of Israel, Sackler Faculty of Medicine, Tel Aviv University, Petah Tikva, Israel

› Author Affiliations

Abstract

Introduction Appendiceal intussusception is a rare condition in children characterized by an invagination of the appendix into the cecum to various degrees. The treatment is appendectomy; however since symptoms are not specific, clinical diagnosis is challenging and frequently only intraoperative. We present a series of five patients with appendiceal intussusception and discuss features that may direct the pediatric surgeon to achieve early recognition and provide optimal treatment.

Materials and Methods The database of a tertiary medical center was retrospectively reviewed for all patients treated for appendiceal intussusception during the period from January 1995 to January 2016. Data collected by chart review included demographics, clinical characteristics, imaging studies, surgical technique, and outcome. The findings were analyzed by descriptive statistics.

Results This series included five patients (two females and three males) with ages ranging between 27 and 42 months (mean: 35.2). Patients presented with intermittent abdominal pain (IAP, all five patients), alternate vomiting (three of five patients), alternate diarrhea (two of five patients), fever (two of five patients), and rectal bleeding (one of five patients). The average length of symptoms was 22.6 days. Eighteen diagnostic studies were performed, including abdominal ultrasound for all patients, barium enema for three patients with secondary ileocolic intussusception, and abdominal computed tomography (CT) for one patient. The average number of studies per patient was 3.6. In surgery, the appendiceal intussusception was found to be complete in four patients, whereas it was partial in the remaining patient. In all patients, appendectomy was performed with resection of a small rim of cecal wall due to marked congestion and edema in an attempt to decrease recurrence.

Conclusion The mainstay of clinical presentation is intermittent abdominal pain while patients may be completely asymptomatic between attacks. Appendiceal intussusception may act as a leading point to ileocolic intussusception and is frequently concealed by it. The treatment is appendectomy. Both pediatric surgeons and radiologists should be aware of this occurrence to provide adequate management and avoid complications.

Keywords

appendix - intussusception - appendiceal intussusception - leading point

Full Text

References

References
1 McKidd J. Case of invagination of cecum and appendix. Edinburgh Med J 1858; 4: 793-796
2 Mcswain B. Intussusception of the appendix. Review of the literature and report of a case. South Med J 1941; 34: 263-271
3 Collins DC. 71,000 human appendix specimens: a final report, summarizing forty years' study. Am J Proctol 1963; 14: 265-281
4 Atkinson GO, Gay Jr BB, Naffis D. Intussusception of the appendix in children. Am J Roentgenol 1976; 126 (06) 1164-1168
5 Chaar CI, Wexelman B, Zuckerman K, Longo W. Intussusception of the appendix: comprehensive review of the literature. Am J Surg 2009; 198 (01) 122-128
6 Seddik H, Rabhi M. Two cases of appendiceal intussusception: a rare diagnostic pitfall in colonoscopy. Diagn Ther Endosc 2011; 2011: 198984
7 Marshall AP, Issar NM, Blakely ML. Appendiceal duplication in children presenting as an appendiceal tumor and as recurrent intussusception. J Pediatr Surg 2013; 48 (04) e9-e12
8 Chua TC, Gill P, Gill AJ, Samra JS. Ileocecal intussusception caused by an appendiceal neoplasm. J Gastrointest Surg 2016; 20 (04) 867-868
9 Nephew L, Hilton S, Falk GW. An unusual cause of abdominal pain. Appendiceal intussusception owing to cecal adenocarcinoma. Gastroenterology 2015; 149 (03) e1-e2
10 Ruiz Marín M, Parra Baños PA, González Valverde FM. , et al. Appendiceal intussusception resulting from endometriosis presenting as acute appendicitis. Am Surg 2010; 76 (08) 906-908
11 Lee CK, Lee SH, Park JY. , et al. Appendiceal intussusception due to a fecalith mimicking a submucosal tumor. Endoscopy 2009; 41 (41) (Suppl. 02) E25-E26
12 Attard TM, Askin FB, Cuffari C. Appendiceal inversion as a lead point for ileocolic intussusception in a child with cystic fibrosis. J Pediatr Gastroenterol Nutr 2000; 31 (03) 300-302
13 Lipskar A, Telem D, Masseaux J, Midulla P, Dolgin S. Failure of appendectomy to resolve appendiceal intussusception. J Pediatr Surg 2008; 43 (08) 1554-1556
14 Iqbal CW, Kamath AS, Zietlow SP. Appendiceal intussusception masquerading as an ileocolic intussusception. J Gastrointest Surg 2012; 16 (05) 1076-1077
15 Offodile II A, Hodgin JB, Arnell T. Asymptomatic intussusception of the appendix secondary to endometriosis. Am Surg 2007; 73 (03) 299-301
16 Voeller GR, Fabian TC. Inversion-ligation appendectomy for incidental appendectomy. Am J Surg 1991; 161 (04) 483-484