A Case Report, Ileo-Ileal Intussusception in
Preterm Neonate: An unusual location
Sunil J Pawar1,2*, Shyamsunder T2, Sarveshwar Reddy1 and Sahai Chethi1
1 Department of Pediatrics, Durgabai Deshmukh Hospital and Research Center, India
2 Thumbay Hospital Hyderabad, India
Submission: December 07, 2017; Published: March 19, 2018
*Corresponding author: Sunil J Pawar, Durgabai Deshmukh hospital and research center, Department of Pediatrics Vidya Nagar, Osmania University Road Medical Campus, India.
How to cite this article:Sunil J Pawar, Shyamsunder T, Sarveshwar Reddy, Sahai Chethi. A Case Report, Ileo-Ileal Intussusception in Preterm Neonate:
An unusual location. Acad J Ped Neonatol. 2018; 6(4): 555749. DOI: 10.19080/AJPN.2018.06.555749
Background: Intussuception is rare cause of surgical emergency in neonate, and still more rarer in preterm neonate. The clinical features can mimic necrotising enterocoloitis or intestinal obstruction. If left untreated, it can lead to adverse outcomes.
Case summary:We report a case of ileo-ileal intussusceptions in a male preterm infant of 28weeks of gestation who was born to a primi mother from south India. The neonate initially had feed intolerance, abdominal distention and recurrent apneas on day 8 of life. The x-ray abdomen also showed pneumatosis intestinalis. We kept necrotising enterocolitis as the primary diagnosis. As the neonate deteriorated, surgical exploration was planned. The diagnosis of ileo-ileal intussusceptions was made only at the time of laprotomy. Resection of the gangrenous segment and anastomosis of the healthy gut was done.
Conclusion: Intussusception can mimic other abdominal conditions in the neonatal period. Timely suspicion and intervention can improve the outcomes.
Keywords: Intussusceptions; Preterm; Ileo Ileal; Necrotising Enter Colitis
Ileo-ileal Intussusceptions occurrence is very rare in neonatal period and even extremely rare in preterm neonate . The early diagnosis is very important to prevent further complications and adverse outcome. Successful management depends on the early diagnosis and immediate management . We present a case of male preterm neonate presented with clinical features of necrotising enterocolitis and finally diagnosed as ileo-ileal Intussusceptions.
A 28 weeks male baby delivered by spontaneous vaginal delivery with birth weight of 1200 grams to primi mother from south India. Neonate cried immediately after birth with an APGAR of 7, 8, 8 at 1, 5 and 10minutes respectively. As the baby was having signs of respiratory distress syndrome started on non-invasive ventilation and received surfactant. Baby started on total parenteral nutrition and colostrum was given from day 1 of life as a unit policy. On day 2, baby started on tube feeding with expressed breast milk. Gradually feeding is increased to full feeds by 6th day of life. On day 8, baby had recurrent episodes of apnea, poor perfusion and abdominal distension. In view of poor respiratory effort baby connected to ventilator and antibiotics were upgraded as per the protocol. On next day greenish aspirates were noted with tensed abdominal distension (Figure 1). X-ray abdomen showed multiple air fluid level with dilated bowel loops and pneumatosis intestinalis which suggestive of necrotising enterocolitis/intestinal obstruction (Figure 2). The exploratory laparotomy was planned. The intra operative findings were suggestive of ileo-ileal intussusceptions with perforation of the intussuscepted segment (Figure 3). Resection of the necrosed segment and reduction of the intussuscepted segment were done.
Post operatively, baby required mechanical ventilation for 4days
then weaned to non invasive mode. Gradually feeding started and
baby discharged on 84th day of life.
Intussuception is rare in the newborn period, very few cases
reported regarding the neonatal intussuception . Intussuception
is a process in which a segment of intestine invaginates into the
adjoining intestinal segment. The reported incidence of preterm
neonate intussuception is 0.3-1.3% of all cases of intussusceptions
. Preterm babies intussuception is still more extremely rare .
The most common site for the intussuception is ileum but can
occur at other different sites also. Usually abdominal distension,
vomiting and bloody stools indicates towards the necrotising
enterocolitis but the diagnosis of intussusceptions also be kept in
mind to avoid the delay in the treatment. Because the treatment
differs from the diagnosis to diagnosis. The early ultrasound of
abdomen or contrast enema can help in the early detection of
the intussuception but sometimes it’s difficult to diagnose if it
is associated with the necrotising enterocoloitis and ascites .
The most common site for the intussuception is ileo colic but it
can occur in the other positions like jejuno jejunal, ileo ileal and
colio colic . The cause for preterm intussuception still not clear,
usually considered as hypoxia or hypo perfusion or some maternal
risk factors which act as lead factors. In our case the ultrasound
couldn’t pick up the intussusceptions may be because of ascites
or largely dilated bowel loops. In our case there are also signs of
necrotising enterocoloitis, it’s difficult to judge that either this is
because of intussusceptions or necrotising enterocolitis preceding
The neonate with high index of suspicion with no evidence
of sepsis, limited to abdomen and clinically stable can undergo
contrast enema or abdominal ultrasonography which is
more helpful for early diagnosis and management of the
SJP, SST and SC are the treating team for the neonate. SC have
collected the relevant clinical data and formulated the initial draft
of case report. SJP and TPO reviewed the literature and corrected
the manuscript. SR is the chief surgeon in the surgical team which
operated on the neonate. He also looked at the initial manuscript
and critically reviewed the same. All the authors have gone
through the final manuscript and accepted it.