Acute ileo-ileal intussusception following a Swenson procedure in a resource-limited setting: a case report

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Introduction and importance: Unexpected postoperative complications associated with the Swenson procedure for the surgical management of Hirschsprung's disease are rarely documented, and postoperative intussusception following this technique is seldom reported. We present a case of acute ileo-ileal intussusception occurring after the Swenson procedure. Case presentation: The patient was a 12-month-old infant who, 16 days after undergoing a Swenson resection, presented with rectal bleeding and abdominal distension. A plain abdominal X-ray demonstrated features of intestinal obstruction, while a longitudinal ultrasound scan revealed a "sandwich" sign, leading to a suspected diagnosis of intussusception. A laparotomy was subsequently performed; intraoperative findings of ileal necrosis necessitated ileal resection and anastomosis. The patient's postoperative course was favorable, and he was discharged on the seventh day. Clinical discussion: This unusual case suggests the existence of a functional mechanism, even in the absence of an identified anatomical cause. According to Swenson, post-surgical intestinal intussusception is uncommon but should be taken into account when making a differential diagnosis for any mechanical intestinal blockage that develops following surgery. Conclusion: Any child who has undergone a Swenson procedure and subsequently presents with rectal bleeding and other signs of intestinal obstruction should undergo advanced diagnostic evaluation to exclude intussusception. The necessity of establishing a postoperative follow-up protocol in resource-limited settings is evident.

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