A Rare Case of Appendicecal Intussusception with Secondary Ileocecal Intussusception

Abstract

Background: Appendiceal intussusception is an uncommon clinical entity that can mimic acute appendicitis or ileocolic intussusception, particularly in pediatric patients. Preoperative diagnosis is challenging due to nonspecific symptoms and overlapping imaging features. Early recognition and timely surgical intervention are essential to prevent complications.

Case Presentation: We report the case of a 12-year-old male who presented with acute right lower abdominal pain, non-bilious vomiting, and decreased appetite for one day. Physical examination revealed localized tenderness and guarding in the right iliac fossa. Ultrasonography showed a mildly thickened inflamed appendix measuring 9 mm with telescoping of the appendix and ileocecal junction into the cecum, suggestive of early appendiculo-ileocecal intussusception. Emergency open appendectomy was performed through a Lanz incision. Intraoperatively, the appendix along with the ileocecal junction was found intussuscepting into the cecum, with the inflamed appendiceal base serving as the lead point. Gentle manual reduction followed by standard appendectomy was carried out. The patient recovered uneventfully and was discharged on postoperative day 5. Histopathological examination confirmed acute appendicitis. At 2-week follow-up, the patient remained asymptomatic.This case highlights the diagnostic difficulty of appendiceal intussusception, which may closely resemble more common causes of pediatric abdominal pain. Imaging may raise suspicion, but definitive diagnosis often occurs intraoperatively. Prompt manual reduction and appendectomy provide excellent outcomes in children when benign pathology is evident.

Conclusion:Early surgical exploration should be considered in suspected atypical appendiceal pathology to ensure accurate diagnosis and prevent complications.