Concomitant intussusception and appendicitis "appendi-sception" in children: A case report and review of literature

Introduction: Pediatric intussusception is the leading cause of bowel obstruction in children under 2 years of age. Concurrent intussusception and appendicitis, known as "appendi-sception" is exceptionally rare in the pediatric population.

Case presentation: A 37-month-old boy presented with periumbilical abdominal pain, vomiting, and red currant jelly stool for two weeks. Clinical examination and ultrasonography confirmed intussusception. Hydroreduction was attempted twice but failed, necessitating surgical intervention. During exploratory laparotomy, ileocolic intussusception and an inflamed appendix were discovered for which an appendectomy was performed. The postoperative course was uneventful, and histopathology confirmed suppurative appendicitis. The patient had no difficulty at the one-year follow-up.

Discussion: Intussusception with appendicitis as a lead point is rare and often challenging to diagnose preoperatively. The literature review revealed 11 pediatric cases, with concomitant intussusception and appendicitis highlighting diagnostic challenges due to symptom overlap. The overlap in symptoms between intussusception and appendicitis complicates diagnosis. Hydroreduction failure should prompt consideration of secondary causes, including appendicitis.

Conclusion: Considering secondary causes in intussusception is crucial, especially when initial management fails. CT scans should be considered in such cases. Appendectomy and manual reduction can effectively manage concurrent intussusception and appendicitis. This case underscores the importance of considering multiple diagnoses in complex pediatric abdominal presentations.