Pneumatosis cystoides intestinalis as a pathologic lead point of an ileocolic intussusception: A case report

Ileocolic intussusception is an acute intestinal obstruction that requires prompt diagnosis and treatment. This case presents a rare pathologic lead point for ileocolic intussusception. A nine-year-old female with a history of functional abdominal pain and constipation presented to the emergency department with acute abdominal pain, bilious emesis and one episode of non-bloody diarrhea. Abdominal x-rays were concerning for a bowel obstruction and an abdominal ultrasound showed an intussusception of unclear location. Subsequent abdominal/pelvic computerized tomography scan identified an ileocolic intussusception with pneumatosis cystoides intestinalis (PCI) acting as a pathologic lead point. The patient underwent two air enema reduction procedures that were deemed to be incomplete. As a result, a diagnostic laparoscopy was performed, which confirmed PCI and identified a previously reduced ileocolic intussusception. Post-operatively, she completed a seven-day course of oral metronidazole and had an unmarkable recovery. At a three-week follow-up visit, persistent PCI was present on abdominal radiographs, which resolved after an additional 14-day course of metronidazole. Further outpatient evaluation revealed no other potential lead points other than that of the known PCI. This case highlights the rare occurrence of pneumatosis cystoides intestinalis acting as a pathologic lead point for ileocolic intussusception in a pediatric patient. Ileocolic intussusception should be considered a potential complication for young patients with PCI.