Abstract:
Background: Intussusception can be defined as the telescoping of a proximal section of the intestine to a distal one. Although it is a major cause of bowel obstruction in children, its incidence during the perinatal period is infrequent. Prompt recognition and immediate treatment are crucial to prevent severe and potentially lethal outcomes. In extremely rare cases spontaneous elimination with auto-anastomosis can occur.
Case presentation: An 8-hour-old male newborn, born by non-instrumental vaginal delivery in a District Hospital after an uneventful supervised pregnancy, presented with abdominal discomfort and distention. Following abdominal massage and stimulation, a tubular structure grossly resembling an intestine, measuring about 50 mm in length, was expelled through the rectum. No bloody stool was identified. Subsequently, the newborn displayed polypnea and hypoxemia (SpO2 84-95%), with peripheral venous blood gas analysis revealing mild respiratory acidosis, and laboratory tests showing no signs of infection. Oxygen therapy and feeding pause were initiated, abdominal ultrasound and radiography were performed, showing aerocolia with significant distension of the descending colon, rectal ampulla and rectum. After discussion with a Pediatric Surgeon, the newborn was transferred to a Neonatal Intensive Care Unit. During the hospitalization the patient maintained regular bowel movements with no other complications. Enteral feeding was initiated on the 3rd day and well tolerated and oxygen was discontinued on the 8th day. The pathology report of the specimen confirmed the clinical impression of an intestinal segment with absolute coagulative necrosis, suggesting the diagnosis of intussusception with auto-anastomosis. About 7 months after the event, the infant remains clinically stable, with appropriate development and without further complications.
Conclusion: Intussusception is a common disease and should be considered in newborns, a population in which a higher suspicion index is crucial. This case represents an extremely rare but favorable outcome.
Audience Take Away Notes:
- I would like to raise awareness about the possibility of intussusception in newborns. Since newborns often display minimal symptoms, it is important to consider intussusception even when the main symptom is abdominal discomfort. An abdominal ultrasound should be promptly requested in such cases
- Learn about the importance of multidisciplinarity in medicine and the constant need for collaboration. In this case, without the pathological analysis of the segment, the diagnosis would never have been considered
- Learn about a rare but benign outcome of a condition that, in most cases, if left untreated, is fatal
