Intussusception as a rare cause of abdominal pain in a child with idiopathic nephrotic syndrome: a case report and review of literature

Intussusception is a rare cause of abdominal pain in children with nephrotic syndrome with only a few reported cases. The best management pathway has still not yet been determined, with two case reports describing the response to intravenous albumin infusion with loop diuretics, and others reporting the need for pneumatic, hydrostatic, or surgical reduction. This case report describes a child with nephrotic relapse with two simultaneous intussusceptions: an ileo-ileal intussusception that responded to intravenous albumin with Furosemide, and a colo-colic intussusception that needed hydrostatic reduction. A seven-year-old boy with idiopathic nephrotic syndrome presented with his first relapse. On admission he had mild periorbital and ankle oedema and was started on prednisolone induction therapy. On day five of induction, the patient developed abdominal pain. He had developed significant weight gain and worsening oedema. The periumbilical pain escalated within hours to an excruciating continuous central abdominal pain with a poor response to analgesics. Even though he developed a fever spike, he remained well perfused with good urine output and no clinical evidence of peritonitis. Inflammatory markers including C-reactive protein were negative. The serum albumin level was markedly low, and the serum amylase level was normal. An intravenous infusion of 20% albumin 1g/kg over 4 hours with Furosemide had negligible effect on abdominal pain. Abdominal ultrasound revealed one ileo-ileal and another colo-colic intussusception. Ultrasound was repeated 5 hours after the albumin infusion which was able to visualize only the colo-colic intussusception, which was then hydrostatically reduced. The ileo-ileal intussusception had already been reduced following the albumin infusion. The boy’s abdominal pain improved soon after, and he made a complete recovery achieving nephrotic remission on day fifteen of induction. A broad differential diagnosis of abdominal pain in children with nephrotic syndrome is vital. If pain persists despite exclusion and treatment of common causes, an ultrasound would be useful for identifying intussusception. Compared with colo-colic intussusception, ileo-ileal intussusception in nephrotic syndrome patients may be more amenable to treatment with intravenous albumin and loop diuretics.