Retrograde Intussusception Through Distal Stoma Of Loop Ileostomy In Paediatric Case; Rare Case Report

Abstract

Background:

Loop ileostomy is frequently performed for fecal diversion in children with intestinal obstruction, perforation, or inflammatory bowel pathology. Although stomal complications such as prolapse, retraction, stenosis, parastomal hernia, and skin excoriation are well recognized, distal limb intussusception remains exceptionally rare. Owing to its nonspecific clinical presentation, it may mimic more common complications such as parastomal hernia or stomal prolapse, making preoperative diagnosis difficult.

Case Presentation:

A 10-year-old boy weighing 26 kg presented for elective closure of a loop ileostomy that had been created six months earlier for intestinal obstruction the history of diagnosis of intestinal tuberculosis obtained which was established by CBNAAT and histopathology showing granulomatous inflammation consistent with tuberculosis, and the patient had completed a six-month course of antitubercular therapy.

Preoperative contrast-enhanced computed tomography demonstrated findings suggestive of a herniation of omental fat along with contrast filled part of ascending colon proximally and few non contrast filled small bowel loops into distal stoma without evidence of bowel obstruction or strangulation. A loopogram confirmed proximal bowel patency.

During elective exploration for stoma closure, a distal limb intussusception with a lead point near the terminal ileum was identified. while preserving the caecum and intussusception was reduced and resection of approximately 15 cm of   ileum was resected till terminal portion colon. Bowel continuity was restored by a side-to-side ileotransverse anastomosis.

The postoperative course was uneventful. The patient tolerated oral feeding well, regained normal bowel function, and remains asymptomatic on follow-up.

Clinical Discussion:

Distal limb intussusception associated with loop ileostomy is exceedingly uncommon, particularly in pediatric patients with intestinal tuberculosis. Radiological imaging may fail to identify the pathology and instead suggest a more common diagnosis such as parastomal hernia. Awareness of this rare entity is essential because delayed diagnosis may result in bowel ischemia or necrosis. Careful intraoperative assessment during planned stoma closure remains crucial.

Conclusion:

 Intussusception through loop ileostomy is extremely rare. Herniation with bowel obstruction may delay treatment. Prompt surgical exploration enables accurate diagnosis and definitive treatment with favorable clinical outcomes as bowel ischaemia necrosis may be detrimental and require extensive resection.