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Infantile Intussusception

Hollier, John M.; Pimpalwar, Ashwin P.; Fishman, Doug S.; Popek, Edwina J.; Himes, Ryan W.

Journal of Pediatric Gastroenterology & Nutrition: April 2014 - Volume 58 - Issue 4 - p e36
doi: 10.1097/MPG.0000000000000304
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Department of Pediatrics, Baylor College of Medicine, Houston, TX.

Address correspondence and reprint requests to John M. Hollier, MD, Department of Pediatrics, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030-3411 (e-mail:

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Submissions for the Image of the Month should include high-quality TIF endoscopic images of unusual or informative findings. In addition, 1 or 2 other associated photographs, such as radiological or pathological images, can be submitted. A brief description of no more than 200 words should accompany the images. Submissions are to be made online at, and will undergo peer review by members of the NASPGHAN Endoscopy and Procedures Committee, as well as by the Journal.

The authors report no conflicts of interest.

An 8-month-old, strictly breast-fed boy presented to our emergency department for persistent hematochezia. Frank bloody stools have been present since age 2 months, when he was diagnosed as having a presumed milk protein allergy; however, restriction of maternal dairy and soy milk since that time brought little improvement. Physical examination was unremarkable and laboratory studies revealed normal coagulation indicators and microcytic anemia with low iron levels. Diagnostic endoscopy was performed upon hospital admission.

Colonoscopy revealed a polypoid lesion, which was encountered in the proximal transverse colon. The base of a stalk was not visualized; rather the proximal colon was filled with viable-appearing intussusceptum (Fig. 1 and video, The patient was transferred to the operating room for laparotomy. The intussusception was surgically reduced and a mid-ileal hyperplastic polyp, acting as a lead point, was resected (Fig. 2). Additionally, a remote Meckel diverticulum was discovered and excised.

Juvenile polyps typically occur in the 2- to 8-year-old age range, and majority of lesions are located in the rectosigmoid colon (1,2). An ileocolonic juvenile polyp causing intussusception happens rarely but has been reported in a 26-day-old neonate (3). In this case, the Meckel diverticulum could have independently contributed to the hematochezia, but its role here is unclear.

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1. Balkan E, Kiristioglu I, Gurpinar A, et al. Sigmoidoscopy in minor lower gastrointestinal bleeding. Arch Dis Child 1998; 78:267–268.
2. Poddar U, Thapa BR, Vaiphei K, et al. Colonic polyps: experience of 236 Indian children. Am J Gastroenterol 1998; 93:619–622.
3. Chen JY, Lin RI, Chao HC, et al. Neonatal ileoileocolic intussusception associated with ileal polyp: report of one case. Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi 1998; 39:203–205.

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© 2014 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,