INTUSSUSCEPTION IN A PRETERM NEW-BORN

Intussusception, the second most common abdominal emergency in childhood, is three times more common in men, and the peak age is before 2 years. The incidence in neonates is 0.3–1.3 per 6000 cases. Most of the cases were misdiagnosed as necrotizing enterocolitis (NEC), causing a delay in treatment. Diagnosis of intussusception requires high suspicion in premature infants. Clinical symptomatology alone is not reliable. These symptoms in premature neonates when constellate with abdominal distension are very suggestive of NEC, the most common acquired gastrointestinal emergency in the NICU.

This leads to delay in treatment of patients. Most of the reported cases were diagnosed preoperatively or at autopsy. The most crucial step during the neonatal period is the timing of surgery. As time passes, the probability of developing ischemia and necrosis increases. Premature neonates are at an increased risk of developing intestinal hypo perfusion causing intestinal stasis and dysmotility, which would be a reasonable explanation for intussusceptions and rapid deterioration. The case presented here differs from those reported in the literature in not only being diagnosed preoperatively, but it is also the earliest diagnosed and the only one in which the intussusception was manually reduced.

Several patients were misdiagnosed with NEC, causing a delay in the operation. The abdominal plain film is not usually helpful in the diagnosis of neonatal intussusception. Although abdominal ultrasonography is the key modality in diagnosis, it has been mostly performed to exclude congenital anomalies, thus underutilizing its usefulness. The decision for performing an operation could be taken after severe clinical deterioration of the patient or in the presence of free air in abdominal graphs. Rectal contrast enema should not be used, despite its usefulness for the diagnosis and treatment of intussusception, due to the vulnerability of the intestines to perforation. Prompt diagnosis and shorter operation time enabled faster improvement and shorter postoperative period in contrast to its counterparts in the literature in which resection of intestines was required.  Open surgery should be the treatment of choice due to the possibility of congenital anomalies. Late diagnosis might result in extended surgery, longer hospital stays, and death, mostly due to sepsis or perforation.

NEC itself may lead to intussusception. The etiology of three patients in the literature has been reported as strictures due to NEC. However, most of the remaining was due to intestinal atresia, while some others were due to Meckel diverticula, duplication cysts, or hematomas. The patient presented here did not have any lead point. The subtle clinical and radiologic features of intussusception in premature neonates are difficult to distinguish from those of early NEC. The application of ultrasound is a feasible method in the early detection of intussusception, facilitating prompt surgical intervention and improving the outcome after surgery.