Delayed diagnosis of transanal prolapse of an ileo-colic intussusception in a 10-month-old infant in rural Cameroon: a case report

BACKGROUND: Transanal protrusion of intussusception is a complication of intussusception which involves the exteriorization of the apex of the intussusceptum through the anus. However, it is rarely reported and its confusion with rectal prolapse often leads to a diagnostic delay. CASE PRESENTATION: A 10-month-old female with no significant past history from a rural area in the Extreme North region of Cameroon was referred from a local health centre to our emergency deparment for an irreducible mass. It was reported that the child had spent 5 days at home on over-the-counter medication, then 3 days at a health centre where she was being treated for a respiratory tract infection and a rectal prolapse. On arrival at our hospital, she was conscious and moderately dehydrated. Cardiopulmonary examination revealed generalized coarse crackles over both lung fields. Her abdomen was tender, with a left upper quadrant mass, absent bowel sounds and a dark anal mass. In view of these, diagnoses of bronchopneumonia, intestinal obstruction and a probable rectal prolapse were made. An exploratory laparotomy was carried out after resuscitation with per-operative findings of a prolapsed ileo- colic intussusception and a necrosed intussusceptum. The necrosed portion was resected and an end-to-end ileo-transverse anastomosis was carried out. The immediate post- operative period was uneventful, but the patient died 3 days after the surgery, from an overwhelming sepsis. CONCLUSIONS: Transanal protrusion of intussusception requires timely surgical intervention to prevent mortality. The similarity in presentation to rectal prolapse coupled with inadequate knowledge on the condition by primary healthcare personnel causes a delay in the diagnosis and an increased mortality. A high index of suspicion is essential for an early diagnosis and an improved referral system for timely and definitive treatment.