Review: A 15-Year-Old Boy with Abdominal Pain, Hematochezia, and Anemia

Abstract

Background: Intussusception is the telescoping of part of the intestine into a more distal segment. It can cause abdominal pain and hematochezia. Intussusception typically presents between 6 and 36 months of age, however, 3-4% of cases can occur in children over 10 years of age and are usually associated with a pathologic lead point. Case information: A 15-year-old male presented to the emergency department with recurrent abdominal pain, diarrhea, and hematochezia. The painless rectal bleeding was first noted when the patient was 9 years old. At that time, abdominal and colonoscopy exams and stool cultures were normal. Laboratory studies were consistent with iron deficiency and β-thalassemia (low Hb, Hct, MCV, elevated TIBC, low ferritin, low serum iron, elevated HbA2), but were otherwise unremarkable. The abdominal pain began 8 weeks prior to admission. The patient has a history significant for iron-deficiency anemia, β-thalassemia minor, and allergic rhinitis with nasal polyps, and a family history of Peutz-Jeghers syndrome with nasal polyposis in two siblings. Prior to admission, an abdominal and pelvic CT scan revealed an ileocolonic intussusception without a distinct mass. A diagnostic procedure and surgical resection revealed a resolved intussusception with a dysplastic polyp as the lead point. No evidence of carcinoma was noted. Conclusions: This case highlights a unique presentation of intussusception with a pathologic lead point in an atypical age group.