Concomitant ileocolic intussusception and perforated appendicitis in a toddler

This is the case of a toddler who presented with abdominal pain, nausea, vomiting and decreased oral intake. The child had a history of constipation treated with milk of magnesia and senna. An abdominal ultrasound revealed an ileocolic intussusception in the right lower quadrant. Despite successful reduction by hydrostatic enema, the child continued to complain persistent right lower quadrant tenderness and demonstrated poor oral intake. On physical examination, the patient expressed exquisite tenderness in the right lower quadrant with voluntary guarding, concerning appendicitis. Repeat abdominal ultrasound revealed resolved intussusception but findings consistent with acute appendicitis with intraluminal faecalith. The child was taken to the operating room for laparoscopic appendectomy. Intraoperatively, perforated appendicitis was found. The child recovered well. This case demonstrates the importance of continuous patient evaluation during treatment, keeping multiple differentials in mind when evaluating paediatric abdominal pain, and the value of interdisciplinary collaboration.