Small bowel intussusception with pelvic plastron secondary to acute appendicitis in child Evangelos Blevrakis a , Zoi Tampakaki a , Anastasia Dimopoulou a , Anna Bakantaki b , Emmanouil Blevrakis b , George Sakellaris a, ⁎ a Department of Pediatric Surgery, University Hospital of Heraklio, Greece b Department of Radiology, University Hospital of Heraklio, Greece Received 12 August 2009; revised 30 October 2009; accepted 4 December 2009 Key words: Acute appendicitis; Intussusception; Child; Ultrasonography Abstract We report an unusual case of a 3-year-old child with appendicitis complicated by ileoileal intussusception. Although acute complicated appendicitis and concurrent ileoileal intussusception represent a possible cause of an acute abdomen, very few cases have been reported in the literature. © 2010 Elsevier Inc. All rights reserved. The association of acute intussusception with acute appendicitis in infancy and childhood is uncommon. The age incidence differs between the 2 conditions. Intussuscep- tion is uncommon in older than 2 years, and acute appendicitis uncommon in younger than 2 years. Acute appendicitis is the most common condition requiring emergency abdominal surgery in childhood. Intussusception occurs frequently in children, and it is usually idiopathic. About 90% of intussusceptions in childhood are ileocolic or ileocecal in nature [1-4]. On the other hand, small bowel intussusception in pediatric patients is uncommon. We report a case where acute appendicitis was compli- cated by small bowel intussusception. 1. Case report A 3-year-old boy was admitted to the hospital as an emergency case. The medical history included attacks of intermittent episodes of colicky central abdominal pain, vomiting, fever, and sore throat for the previous 2 weeks. The patient had been examined by a general practitioner who had administered amoxicillin/clavulanic acid, on an outpa- tient basis, because of the possibility of a streptococcal pharyngitis. On examination, the patient had diffuse abdominal pain, fever, tenderness, and guarding on palpation of the right iliac fossa. Brownish-colored, loose bowel motions with mucus were also noted. There was no rectal bleeding. Investigations showed a leukocytosis (white blood count, 27.6 × 10 9 /L; neutrophils, 80%). Chest x-ray, urine specimen, and stool culture were unremarkable. Ultrasound examination of the abdomen revealed intussusception of the small bowel (Fig. 1) and pelvic plastron secondary to acute appendicitis (Fig. 2). The child was operated on, by performing a right transverse incision. After entering the abdomen, an appendiceal pelvic plastron and ileoileal intussusception were visualized. Therefore, an appendicec- tomy was performed, and the ileoileal intussusception manually reduced. There was no evidence of any intramural lead point. The rest of the bowel was normal, free of mural lesions. Postoperatively, a combination of broad-spectrum antibiotics were administered for 5 days, and the patient was ⁎ Corresponding author. EL. Venizelou 105, GR-70014. E-mail address: gsakell@mycosmos.gr (G. Sakellaris). www.elsevier.com/locate/jpedsurg 0022-3468/$ – see front matter © 2010 Elsevier Inc. All rights reserved. doi:10.1016/j.jpedsurg.2009.12.010 Journal of Pediatric Surgery (2010) 45, E5–E7