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• W3144426183 abstract "An 8-year-old White female patient was admitted with nonbloody, nonbilious vomiting and paroxysmal abdominal pain in the right lower quadrant. She had a history of chronic constipation and recurrent, self-resolving vomiting episodes. She had a family history of migraines but denied headaches, photophobia, phonophobia, or abdominal pain during her stereotypical episodes. She had been admitted at age 3 years for a protracted episode with weight loss. An extensive workup was unrevealing, and her presumed diagnosis was post-viral gastroparesis. On examination, she was noted to be thin (body mass index at the 27th percentile) and in visible discomfort. Her abdomen was tender to palpation but soft, nondistended without guarding, tenderness, or rebound tenderness. Comprehensive metabolic panel, complete blood count, and urinalysis were normal. Her serum lipase was elevated at 97 units per liter (reference range 13-60 U/L). A computed tomography scan of the abdomen obtained while the patient was symptomatic showed a small bowel intussusception (Figure 1). Her abdominal pain resolved without intervention. A subsequent abdominal ultrasound scan obtained while the patient was asymptomatic was normal. Her symptoms returned, and repeat ultrasound scan showed 2 adjacent areas of small bowel intussusceptions (Figures 2 and 3) without ileocolic involvement. Symptoms resolved spontaneously, and follow-up ultrasound scan showed resolution of the intussusceptions.Figure 2Ultrasound scan showing small bowel intussusception in the right lower quadrant (white plus signs).View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 3Ultrasound scan showing small bowel intussusception in the right middle quadrant (white plus signs).View Large Image Figure ViewerDownload Hi-res image Download (PPT) Intussusception is described as the “telescoping” of a proximal intestinal segment into a distal segment, most commonly involving the ileum and cecum.1Baker R.D. Acute abdominal pain.Pediatr Rev. 2018; 39: 130-139Crossref Scopus (3) Google Scholar The mesentery may be pulled into the intussusception, increasing the risk for ischemia and necrosis.1Baker R.D. Acute abdominal pain.Pediatr Rev. 2018; 39: 130-139Crossref Scopus (3) Google Scholar The incidence of intussusception is 1.5-4 per 1000 children, with a peak incidence in those younger than 2 years.2Bonasso P.C. Turner J.L. Vaughan R.A. Nakayama D.K. Cystic fibrosis diagnosed via presentation of intussusception in childhood.J Pediatr Surg Case Rep. 2015; 3: 91-92Crossref Scopus (1) Google Scholar The majority of cases are idiopathic but 10% involve a lead point.3Lehnert T. Sorge I. Till H. Rolle U. Intussusception in children—clinical presentation, diagnosis and management.Int J Colorectal Dis. 2009; 24: 1187-1192Crossref PubMed Scopus (53) Google Scholar Commonly identified lead points include Meckel diverticulum, polyps, intestinal duplications, mesenteric cysts, intramural hematoma, and lymphoma.3Lehnert T. Sorge I. Till H. Rolle U. Intussusception in children—clinical presentation, diagnosis and management.Int J Colorectal Dis. 2009; 24: 1187-1192Crossref PubMed Scopus (53) Google Scholar Although intussusception is common, a simultaneous double intussusception is not. Yu et al reported 15 cases of double simultaneous intussusceptions with 5 idiopathic, 8 involving lead points, and 2 postoperatively.4Yu M. Fang Z. Shen J. Zhu X. Wang D. Shi Y. Double simultaneous intussusception caused by Meckel's diverticulum and intestinal duplication in a child.J Int Med Res. 2018; 46: 3427-3434Crossref PubMed Scopus (6) Google Scholar In our patient, cystic fibrosis (CF) was considered, given multiple small bowel intussusceptions along with the patient's chronic gastrointestinal complaints and thin body habitus. Sweat chloride testing results were intermediate at 53 and 58 mmol/L, with values >60 mmol/L indicative of CF. Genetic testing revealed 2 mutations in the CF transmembrane conductance regulator gene, including c3873+2T>C, a disease-causing mutation, and (TG)13-5T, a mutation associated with a mild form of CF. The incidence of intussusception in CF is 1%-2%, with a peak incidence at 9-9.5 years of age.2Bonasso P.C. Turner J.L. Vaughan R.A. Nakayama D.K. Cystic fibrosis diagnosed via presentation of intussusception in childhood.J Pediatr Surg Case Rep. 2015; 3: 91-92Crossref Scopus (1) Google Scholar The lead point is not always discovered but has been attributed to inspissated stool adhering to the intestinal wall.2Bonasso P.C. Turner J.L. Vaughan R.A. Nakayama D.K. Cystic fibrosis diagnosed via presentation of intussusception in childhood.J Pediatr Surg Case Rep. 2015; 3: 91-92Crossref Scopus (1) Google Scholar" @default.
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• W3144426183 date "2021-07-01" @default.
• W3144426183 modified "2023-09-26" @default.
• W3144426183 title "Simultaneous Double Intussusception in a Patient with Cystic Fibrosis" @default.
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• W3144426183 doi "https://doi.org/10.1016/j.jpeds.2021.03.054" @default.
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