Intussusception in an infant with acute lymphoblastic leukemia: a case report and review of the literature.
OBJECTIVE
An ileocecal intussusception developed in a 7-month-old infant with acute lymphoblastic leukemia (ALL) during induction therapy. Gastrointestinal complications, especially intussusception, are rare in children with ALL.


METHODS
The history of a 7-month-old white boy with ALL in whom an ileocecal intussusception developed 1 week into induction chemotherapy was reviewed. In addition, a literature search was performed to determine the prevalence of this complication in children with acute leukemia.


RESULTS
On day 4 of induction chemotherapy for B-lineage ALL, the infant developed abdominal distension with hypoactive bowel sounds. After a barium enema and abdominal computed tomography scan, the symptoms were determined to be caused by an ileocecal intussusception. Chemotherapy was resumed 1 week after immediate surgical intervention (reduction of intussusception and resection of the "leading edge") with an uneventful post-operative recovery. Histopathologic examination of the resected edge revealed an intact mucosa with areas of necrosis in the submucosa. This was associated with a dense lymphoid infiltrate composed of mature lymphocytes and leukemic cells, edema, and focal necrosis. Despite a 1-week delay in chemotherapy, a complete remission was documented at day 32.


CONCLUSIONS
The prevalence of intussusception in children with ALL and its possible etiology are discussed. The pathologic changes, clinical manifestations, and treatment outcome are briefly mentioned.
Manglani
M V
MV
Division of Pediatric Hematology-Oncology, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, USA.
Rosenthal
J
J
Rosenthal
N F
NF
Kidd
P
P
Ettinger
L J
LJ
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007077:Ileal Diseases / Q000139:chemically induced; D007080:Ileocecal Valve; D007223:Infant; D007443:Intussusception / Q000139:chemically induced*; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*