Intussusception in children: Current perspectives on etiopathogenesis, diagnosis, and a clinical case of recurrent course

Abstract

Intussusception is one of the most common causes of acute surgical emergencies in early childhood. In cases of multiple recurrence, extensive diagnostic search should be performed to exclude secondary causes, such as infectious, anatomical, inflammatory, and allergic gastrointestinal diseases. We describe a clinical case of a 9-month-old child with 4 times recurrent intussusception in various locations over a two-month period. The onset of the disease coincided with the introduction of cottage cheese as a complementary food, and was accompanied by the appearance of blood-streaked stools. Later on, the child was hospitalized multiple times due to ileocolic and ileoileal intussusceptions, which were confirmed by ultrasound examination and relieved by non-surgical treatments, including pneumoirrigoscopy. Due to recurrent character of the disorder, additional examination was performed, which revealed a significant increase in fecal calprotectin levels (over 800 mg/kg), an increase in circulating IgA antibodies to gliadin (up to 82.5 IU/ml), and a borderline ASCA IgG level. The bloody stools, the association of clinical symptoms with the introduction of a dairy product, and laboratory test results allowed us to consider gastrointestinal food allergy, celiac disease, and inflammatory bowel disease in the differential diagnosis. Based on the results of a consultation with an allergist/gastroenterologist, a diagnosis of GI food allergy mediated by IgE-dependent and IgEindependent mechanisms was established. This case demonstrates that recurrent intussusception in early childhood may be associated with allergic inflammation of the intestinal wall and requires a multidisciplinary approach involving a pediatric surgeon, gastroenterologist, and allergist. The practical significance of this case lies in the need for a thorough examination of children with multiple intussusceptions, particularly in the presence of bloody stools, the relationship between symptoms and the introduction of complementary foods, and signs of intestinal inflammation, to ensure the timely verification of a cause and the effective prevention of recurrence.