Small bowel-small bowel intussusception with high grade obstruction due to intramural submucosal ileal hamartoma in a 5-year-old child: A case report

Highlights • Intussusception in children can present with evidence of small bowel obstruction. • Ultrasound can show a pathologic lead point which requires surgical intervention. • Surgery should begin with a laparoscopic approach and converted to open procedure if needed.
Introduction Intussusception is a common cause of emergency in children. We report a unusual case of intestinal obstruction due to small bowel-small bowel intussusception with an intestinal hamartoma as the lead point. Presentation of the case A 5 year old boy presented to the ED with worsening abdominal pain, emesis and bloody diarrhea. An abdominal radiograph showed evidence of small bowel obstruction and US confirmed a small bowel-small bowel intussusception with a likely cystic mass as the lead point. Given these findings, surgery was performed and revealed an intestinal hamartoma as a lead point. Discussion Intussusception in children is mostly idiopathic and usually amenable to reduction by air enema. The presence of a lead point is unusual and usually requires surgical intervention. Conclusion We report an unusual case of intussusception with small bowel obstruction due to intestinal hamartoma, a rare pathologic finding as a lead point for intussusception. Ultrasound was useful for diagnosing the intussusception and confirming the presence of a lead point.