Intestinal intussusception caused by a Meckel's diverticulum in a preterm infant: A case report

Introduction: Neonatal intussusception is a rare cause of bowel obstruction, particularly in preterm infants, and may mimic necrotizing enterocolitis. When a lead point is identified, Meckel's diverticulum is among the most reported etiologies. Case presentation: We report a case of a 15-day-old male preterm infant (gestational age 31+3 weeks; birth weight 1160 g), born via cesarean section due to breech presentation and premature rupture of membranes. Originally admitted to the neonatal intensive care unit for respiratory distress requiring intubation, he subsequently developed progressive abdominal distension, decreased stool output, and bilious vomiting. Abdominal ultrasound suggested small-bowel obstruction, and contrast enema demonstrated a rectosigmoid transition zone, prompting evaluation for Hirschsprung's disease. However, rectal suction biopsy revealed ganglion cells, rulling out the condition. Abdominal CT showed marked bowel dilation and upon subsequent review indentified a layered “target” mass consistent with intussusception. Exploratory laparotomy on day 15 confirmed ileoileal intussusception with a necrotic segment and Meckel's diverticulum as the lead point. Resection with primary end-to-end anastomosis was performed, followed by a second-look operation 24 hours later confirmed anastomotic integrity. Bowel function returned by postoperative day 5, and the early postoperative course was uneventful. The infant was successfully weaned from ventilatory support, resumed oral feeding, and demonstrated appropriate weight gain. Outpatient follow-up over 1–3 months confirmed normal growth and neurodevelopmental progress, with no recurrence of bowel obstruction and no anastomotic complications. Conclusion: Neonates presenting with bilious emesis should undergo immediate imaging to rule out midgut volvulus. If a midgut volvulus has been ruled out but the bilious emesis persists, an exploratory laparotomy should be done without delay. Intussusception due to a Meckel's diverticulum should be included in the preoperative differential diagnosis.