Appendiceal duplication leading to recurrent ileocolonic intussusception: A case report

Appendiceal duplication is a rare congenital anomaly of the appendix, often identified incidentally, and is estimated to be present in 0.004–0.009% of the population. Rarely, an appendiceal duplication may act as a lead point for recurrent ileocolonic intussusception. This case describes a 15-year-old male with celiac disease who initially presented with ileocolonic intussusception for which he underwent exploratory laparotomy for intussusception reduction at a local institution. Intra-operatively, there was concern for an underlying colonic polyp. He subsequently underwent colonoscopy and CT enterography, which both revealed no evidence of a defined pathologic lead point. He then presented two months later to our institution with recurrent ileocolonic intussusception, which was reduced via air contrast enema. He was monitored overnight and discharged the following day. Three days after this, he again developed abdominal pain and was identified to have recurrent ileocolonic intussusception, which was successfully reduced via air contrast enema. Repeat CT enterography identified no pathologic lead point. He was monitored overnight and discharged with plans for outpatient ileocecectomy. One day later, however, his pain recurred, and he was again diagnosed with ileocolonic intussusception via abdominal ultrasound. This was successfully reduced via air contrast enema, and he was taken to the operating room for planned laparoscopic ileocecectomy to prevent further recurrence. Intra-operatively, there was no evidence of a clear pathologic lead point, but there were significant adhesive colonic peritoneal bands noted, as well as an enlarged but not inflamed appendix. On final pathology, he was found to have appendiceal duplication with otherwise benign ileocecal pathology. He recovered uneventfully in the hospital and was discharged on post-operative day two. He has had no further episodes of recurrence for four months post-operatively. Appendiceal duplication is a rare congenital anomaly that should be considered as a potential etiology for otherwise unexplained recurrent ileocolonic intussusception.