Colonic Polyp as Lead Point for Intussusception
A 6-year-old boy with a history of juvenile polyposis coli presented with a 1-day history of abdominal pain and diarrhea with streaks of dark red blood. He initially had no fever, nausea or vomiting. Abdominal pain was generalized and worse in the left upper quadrant. The examination was significant for nontender abdomen with a firm loop of bowel palpable in the left upper quadrant. Three-way abdominal x-ray showed right colonic pneumatosis intestinalis. Patient was treated with intravenous fluids and started on triple antibiotics. The pneumatosis resolved, but 24 hours later he developed nausea and bilious emesis. A CT scan after oral contrast (Figs. 1 and 2) showed a transverse/descending colonic–colonic intussusception with a polyp as a lead point. Air enema was performed with complete reduction of the intussusception. The patient underwent colonoscopy 1 hour later, which showed several large polyps in the descending colon and rectum, and 1 large polyp in the transverse colon with edematous and erythematous mucosa proximal and distal to the polyp (Fig. 3). This lead point polyp was removed endoscopically and the patient had no further episodes of intussusception.
This case illustrates an important finding in a patient with juvenile polyposis coli. Not only are patients at risk for rectal bleeding and malignant transformation of their polyps but they are also at increased risk for intussusception. Intussusception should always be considered in the differential diagnosis of abdominal pain and rectal bleeding in a child with juvenile polyposis coli.
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