Idiopathic intussusception caused by a polyp in the appendix: A case report

Intussusception, primary or secondary, is a common cause of mechanical obstruction in infants and children. Rarely, however, an intussusception is caused by a lesion of the appendix. A thirty-two-month-old female was brought to the emergency department with abdominal pain and passage of red currant jelly stool. The abdominal exam revealed a palpable mass in the upper abdomen. Ultrasound examination of the abdomen showed the classical signs of an ileocolic intussusception: target sign in the transverse view and pseudokidney sign in the longitudinal view. A hydrostatic barium enema reduction was done. Successful reduction of the intussusception was confirmed by seeing the contrast reflux into the ileum. However, several hours later the abdominal pain recurred, and a follow-up ultrasound showed recurrence of the intussusception. The patient was taken to the operating room for an exploratory laparotomy. Following the manual reduction of the intussusception, a palpable mass was identified at the base of the appendix protruding into the cecum. An enterotomy was made on the cecum near the base of the appendix, and a polyp was found protruding from the inside the appendix into the cecum. We did an appendectomy, which included the polyp. The patient recovered uneventfully. The pathology analysis was consistent with a juvenile polyp. Although rare, appendiceal polyps can serve as a lead point for intussusception of the ileocecal region. Such type of intussusception may recur after a reduction enema and may require a surgical exploration.