Retrograde Intussusception and Giant Meckel's Diverticulum: An Uncommon Encounter

Abstract

Retrograde intussusception (RINT) and giant Meckel's diverticulum (MD) are both rare pathologies and are seldom encountered in surgical practice. Thus, it is exceptional for both conditions to be seen in the same patient, with very few published case reports in the paediatric population. This case describes a three-month-old male who was referred to our paediatric surgery unit following a diagnosis of intussusception on an ultrasound scan. The patient presented to the paediatric emergency department one day prior with a clinical history of fever, cough, vomiting and irritability. After resuscitation, the patient was admitted for overnight observation in the paediatric ward. However, the patient's symptoms persisted with notable abdominal distension. Abdominal X-ray (AP erect) showed features of small bowel obstruction, while abdominal ultrasound showed a concentric mass in the right upper quadrant consistent with intussusception. Following this diagnosis of intussusception, pneumatic enema reduction under ultrasound guidance was attempted but proved unsuccessful. The patient was then taken for emergency laparotomy. At surgery, an ileo-ileal RINT with a proximal giant MD was discovered. Successful manual reduction of the RINT and wedge resection of the giant MD with primary ileo-ileal anastomosis was performed. The postoperative recovery and follow-up were uneventful.

Keywords: giant meckel’s diverticulum; ileo-ileal intussusception; meckel’s diverticulum; paediatric intestinal obstruction; retrograde intussusception.

Figure 1. Preoperative radiological investigations

(A) Erect abdominal X-ray showing features of small bowel obstruction with a very dilated segment of bowel in the right upper quadrant (black arrow). (B) Abdominal ultrasound scan showing a concentric mass (white arrow).

Figure 2. Intraoperative findings

A segment of ileo-ileal retrograde intussusception (black arrow) and a giant Meckel’s diverticulum proximally (white arrow).

Figure 3. Post-reduction findings

Viable small bowel on manual reduction of the retrograde intussusception (white arrow), and sub-centimetre mesenteric lymph nodes (black arrows).