January 1993, Volume 43, Issue 1

Case Reports

INTUSSUSCEPTION IN AN INFANT CAUSED BY ABERRANT PANCREAS

A. Erdener  ( Departments of Paediatric Surgery and Pathology, Ege University, Faculty of Medicine, Izmir, Turkey. )
A. Avanoglu  ( Departments of Paediatric Surgery and Pathology, Ege University, Faculty of Medicine, Izmir, Turkey. )
G. Ozok  ( Departments of Paediatric Surgery and Pathology, Ege University, Faculty of Medicine, Izmir, Turkey. )
AK. Genc  ( Departments of Paediatric Surgery and Pathology, Ege University, Faculty of Medicine, Izmir, Turkey. )
M. Tuncyurek  ( Departments of Paediatric Surgery and Pathology, Ege University, Faculty of Medicine, Izmir, Turkey. )

The etiology of most intussusceptions is unknown. However, there are a few intussusceptions which are initiated by lesions of the bowel, so-called leading points. Occasionally an aberrant pancreatic tissue may cause intussusception in the paediatric age group. Such a case of aberrant pancreas leading to ilco-ileal intussusception in an infant is presented.

CASE REPORT

An eight month old male was transferred to our department for bilious vomiting, abdominal distension and failure to pass gas and stool. Past medical and family history were unremarkable and the boy had been perfectly well prior to the onset of these symptoms. On physical examination the abdomen was distended hut soft, no mass was palpable. Rectum was empty on digital rectal examination. He had the signs and symptoms of dehydration. Laboratory studies showed a mild leukocytosis with a slight left shift and moderately severe metabolic acidosis. Abdominal film demonstrated dilated proximal small bowel with air-fluid levels (Figure 1).

After fluid and electrolyte correction the infant was explored with the preoperative diagnosis of intestinal obstruction. At laparotomy, an ileo-ileal intussusception approximate­ly 50 cm from the ileo-cecal valve was found. Attempts to reduce the intussusception were unsuccessful, the in­volved segment was resected and end-to-end anas­tomosis was performed. The postoperative course was uneventful. The resected specimen consisted of a 25 cm length of small bowel. A microscopic section of this specimen showed that it consisted of submucosal pancreatic tissue with necrosis and foci of hemorrhage (Figure 2).

DISCUSSION

Childhood intussusception is usually idiopathic in origin. In only a small proportion is a pathological lesion at the leadpoint identified. The most common specific leadpoini. causing intussusception is a Meckel’s diver­ticulum, followed by small bowel polyps, lymphosar­comas and duplication cysts1,2. Occasionally, aberrant pancreatic tissue may be found in abdominal and intrathoracic locations3. Although aberrant pancreas and intussusception are not unusual conditions, the associa­tion of the two is seldom seen. Only four paediatric cases of heterotopic pancreas causing small bowel intussus­ception were found in literature4-7. Heterotopic pancreas is a rare cause of small bowel intussusception but must be considered as a leadpoint. Sections should be taken of all leading edges of intussusceptions to demonstrate the possible presence of a small, submucosal aberrant pancreas. The treatment of choice for ectopic pancreas in bowel wall is a segmental resection of the involved intestine.

REFERENCES

1. Em, SB. Leading points in childhood intusstssception. J. Pcdiatr. Surg., 1976;11:209-11.
2. Ong. N.T. and l3easlry, S.W. The leadpoirit in intuasusception. 3. Pediatr. Surg, 1990;25:640-43.
3. Moen, 3. and Mack, E. Small-bowel obstruction caused by heterotopic pancreas in an adult Am.Surg., 1989;55:503-4.
4. Barbosa, J.J., Dockerry, MB. and Waugh, 3M. Pancreatic heteroropia. Review of the literature and reporl of 41 authenticated surgical cases of which 25 were clinically significant. Surg. Gynecol. Obaret., 1946;82:527-46.
5. Carleton, CC. and Ackerbaum, R. Inrussuaception secondary to aberrant pancreas ins child. JAMA., 1976;236:1047.
6. Ravitch, MM. Intussusception in pediatric surgery. Edited by K.J. Welch, J.G. Randolph, M.M. Ravitch, J.A. O\\\'Neill and M.I. Rowe. 4th ed. chicago, Year Book, 1986, vol. 2, pp. 868-82.
7. Sugimaro, K. Case of intussusception in an infant caused by accessory pancreas. Surg. Ther., 1967;16:251-54.

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