Introduction:

We present an atypical case of intestinal intussusception as a rare cause of chronic abdominal pain in children, highlighting the need for a comprehensive diagnostic approach to prevent complications and provide timely management.

Clinical case:

8-year-old male student, with no relevant pathological history, who repeatedly consults for episodes of abdominal pain, sudden, moderately intense, crampy abdominal pain in the hypogastrium and midgastrium radiating to the right iliac fossa, with periods of apathy, vomiting, difficulty defecating and abdominal distension. He required multiple rectal lavage and enemas, eventually relieving symptoms. Paraclinical studies were uncontributory; however, abdominal ultrasound revealed a bull's-eye image with hyperechoic layers in the right iliac fossa, and abdominal CT revealed ileo-ileal intestinal intussusception with scant adjacent fluid. Upper gastrointestinal videoendoscopy revealed Helicobacter pylori associated gastritis, and colonoscopy revealed colonic polyps and nodular lymphoid hyperplasia. Surgery identified an ileoileal intussusception 80 cm from the ileocecal valve, with two mamelon-shaped lesions, one purplish and the other yellowish, accompanied by a single mesenteric adenopathy. Biopsy revealed Meckel's diverticulum with heterotopic mucosa.

Conclusion:

Chronic intussusception represents a diagnostic challenge, especially in the presence of Meckel's diverticulum, given its nonspecific symptoms and subacute course. Low clinical suspicion can delay diagnosis, increase risk of complications and need for more complex interventions.