Colocolonic Intussusception
A previously healthy 5-year-old boy was brought to the surgery clinic with a 2-day history of intermittent abdominal pain and mucus-covered stool. On physical examination, there was pain on palpation of the periumbilical region but no rebound or guarding. Ultrasonography of the abdomen showed no abnormalities. Owing to the patient’s ongoing severe pain, computed tomography of the abdomen was performed, which revealed a target sign (Panel A, asterisk; transverse view) and telescoping (Panel B, asterisk; sagittal view) in the descending colon. A diagnosis of colocolonic intussusception was made. Colonic intussusception is a rare cause of intestinal obstruction in children, and most cases are ileocolic rather than colocolonic. A pathologic lead point, typically a juvenile polyp, is present in the majority of cases. After a pneumatic reduction was performed, the patient’s symptoms resolved. An abdominal radiograph obtained after the procedure showed a polypoid mass in the left upper quadrant (Panel C). A subsequent colonoscopy revealed a 2.5-cm pedunculated polyp, which was thought to be the intussusception lead point (Panel D). The polyp was resected, and histopathological examination showed it to be a hamartoma. At a 2-month follow-up visit, the patient had had no recurrence of symptoms.