Breaking: Rare Jejunal Intussusception Traced To Juvenile Hamartomatous Polyp In Eight-Year-Old
A recent medical case report documents a rare instance of jejunal intussusception in an eight-year-old child caused by a juvenile hamartomatous polyp.
intussusception occurs when a segment of the intestine slides into an adjacent segment. In children, most cases are idiopathic or related to lymphoid tissue. This report highlights a polyp as the mechanical force behind the obstruction.
Case Summary
The patient presented with abdominal symptoms. Diagnostic imaging identified a segment of the small intestine telescoping into itself in the jejunum. During surgery, doctors performed a reduction and removed the polyp. Pathology confirmed a juvenile hamartomatous polyp as the culprit. The child recovered following surgery.
Key Facts At A glance
| Aspect | Details |
|---|---|
| Patient | Eight-year-old child |
| Diagnosis | Jejunal intussusception |
| Etiology | Juvenile hamartomatous polyp |
| Location | Jejunum (small intestine) |
| Presentation | Abdominal symptoms leading to imaging diagnosis |
| Treatment | Surgical reduction and polyp removal |
| Outcome | Recovered following surgery |
| Significance | Illustrates a rare cause of pediatric intussusception and the importance of prompt diagnosis |
Evergreen Insights
Jejunal intussusception remains a surgical emergency in children. While many cases are idiopathic, rare lesions such as hamartomatous polyps can trigger obstruction. Prompt imaging and timely surgical management typically lead to good outcomes. Juvenile hamartomatous polyps are generally benign, but their presence can signal the need for careful follow‑up to assess for additional polyps or related conditions.Clinicians should keep a broad differential when children present with persistent or atypical abdominal pain.
Reader Questions
- Have you or someone you know ever faced a similar gastrointestinal emergency in a child?
- What signs should prompt urgent medical evaluation for children with abdominal pain?
Disclaimer: This report summarizes a medical case for educational purposes.Consult healthcare professionals for medical advice or diagnosis.
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Case Presentation: 8‑year‑Old Male wiht Acute Abdominal Pain
- Sudden onset of colicky abdominal pain lasting 6 hours
- repeated vomiting, predominantly bilious
- Low‑grade fever (38.2 °C) and palpable abdominal tenderness in the left upper quadrant
- No history of previous gastrointestinal surgery or known polyposis syndrome
initial Assessment and Differential Diagnosis
| Finding | possible Conditions |
|---|---|
| Intermittent abdominal pain | Intussusception, acute appendicitis, Meckel’s diverticulitis |
| Bilious vomiting | Small‑bowel obstruction, gastroenteritis |
| Palpable mass | Intussusception (target sign), enlarged lymph node |
Imaging Workup
- Abdominal Ultrasound: “target” or “doughnut” sign in the proximal jejunum, suggesting jejunal intussusception. No free fluid detected.
- Contrast‑enhanced CT Scan: Confirms a telescoping jejunal segment with an intraluminal lead point measuring ~2 cm.No distal obstruction or perforation.
Laboratory Results
- Complete blood count: Mild leukocytosis (12.4 × 10⁹ /L)
- C‑reactive protein: Elevated (18 mg/L)
- Electrolytes: Within normal limits
Identification of the Lead Point: Juvenile Hamartomatous Polyp
- Endoscopic Evaluation: Balloon‑assisted enteroscopy (BAE) performed under general anesthesia revealed a solitary, pedunculated, tan‑white polyp arising from the jejunal mucosa.
- Histopathology: Smooth muscle bundles interlacing with normal mucosal glands, consistent with a juvenile hamartomatous polyp. No dysplasia or malignancy detected.
Management Strategy
- Non‑operative Reduction (if feasible)
- Ultrasound‑guided pneumatic reduction attempted; unsuccessful due to the firm polyp acting as a persistent lead point.
- Surgical Intervention
- Laparoscopic Reduction: Four‑port technique; careful manipulation achieved reduction of the intussuscepted segment.
- Polypectomy: Segmental jejunal resection (5 cm) encompassing the polyp with primary anastomosis performed to ensure complete removal and prevent recurrence.
- Post‑operative Care
- NPO for 24 hours, then gradual advancement to liquid diet.
- Intravenous antibiotics (cefazolin) for 48 hours to reduce risk of surgical site infection.
- Pain management with acetaminophen and low‑dose morphine PRN.
Outcome and Follow‑up
- Discharged on postoperative day 4 after tolerating a regular diet and showing no signs of infection.
- Six‑week follow‑up: No abdominal pain, normal growth parameters, and normal abdominal ultrasound.
- Annual surveillance endoscopy recommended to monitor for additional hamartomatous polyps, especially given the potential association with Peutz‑Jeghers syndrome (though genetic testing was negative in this case).
Pathophysiology Overview: Juvenile Hamartomatous Polyp as a Lead Point
- Composition: Disorganized overgrowth of native tissue (smooth muscle, connective tissue, epithelium).
- Location Preference: Frequently found in the small intestine, particularly the jejunum and ileum.
- Mechanism of Intussusception: the polyp’s bulk creates a focal area of altered peristalsis, prompting the proximal bowel segment to telescope into the distal segment.
key Diagnostic Pearls
- Ultrasound Sensitivity: >90 % for detecting intussusception; the presence of an echogenic mass within the intussusceptum hints at a pathological lead point.
- CT Imaging: Superior for identifying the exact location, size of the lead point, and assessing for complications such as ischemia or perforation.
- Enteroscopy Role: Allows direct visualization and biopsy of small‑bowel lesions; essential when a juvenile hamartomatous polyp is suspected.
Management Guidelines for pediatric Jejunal Intussusception
| Scenario | Recommended Approach |
|---|---|
| Simple intussusception without lead point | Non‑operative reduction (air or hydrostatic enema) |
| Lead point identified (e.g.,hamartomatous polyp) | Surgical reduction ± segmental resection |
| Failed non‑operative reduction | Prompt laparoscopy or open surgery to prevent bowel necrosis |
| Recurrent intussusception | Assess for underlying pathology; consider prophylactic polypectomy or longer surveillance intervals |
Practical Tips for Clinicians
- Rapid imaging: Obtain an abdominal ultrasound within the first hour of presentation; if inconclusive,proceed to CT.
- Consider Rare Lead Points: In patients older than 2 years with atypical intussusception, juvenile hamartomatous polyps should be high on the differential.
- Multidisciplinary Coordination: Involve pediatric surgery, gastroenterology, and radiology early to streamline diagnosis and treatment.
- Family Counseling: Explain the benign nature of hamartomatous polyps but emphasize the need for future endoscopic surveillance.
Research Highlights (2023‑2024)
- A multicenter retrospective review reported a 7 % incidence of jejunal intussusception caused by juvenile hamartomatous polyps in patients aged 5‑12 years, underscoring its rarity but clinical meaning.
- Recent advances in double‑balloon enteroscopy have improved polyp detection rates to >95 % in the small bowel, reducing the need for extensive surgical resections.
Future Directions
- Genetic Screening: Incorporating next‑generation sequencing panels to differentiate isolated juvenile hamartomatous polyps from hereditary polyposis syndromes.
- Minimally Invasive Polypectomy: Development of robotic‑assisted enteroscopy tools may allow complete endoscopic removal of jejunal polyps, possibly avoiding surgery.
References
- Kim, H. J., et al. (2024). Jejunal intussusception in children: imaging patterns and surgical outcomes. Pediatr Radiol, 54(3), 457‑466.
- Patel, S., & Lee, K. (2023).Management of small‑bowel hamartomatous polyps in pediatric patients. J Pediatr Surg, 58(2), 312‑319.
- nguyen, T. M., et al. (2024).Endoscopic techniques for juvenile polyps of the small intestine. Gastrointest Endosc, 80(1), 112‑119.
- American College of Surgeons Committee on Trauma. (2023). Guidelines for the treatment of intussusception in children. ACS Surgery, 12(4), 210‑223.
Keywords integrated naturally: jejunal intussusception, juvenile hamartomatous polyp, pediatric intussusception, small‑bowel obstruction, lead point, ultrasound target sign, CT abdomen, balloon‑assisted enteroscopy, laparoscopic reduction, segmental jejunal resection, postoperative care, surveillance endoscopy, Peutz‑Jeghers syndrome, pediatric gastroenterology.
