Appendicular intussusception with lymphoid hyperplasia.

A 4-year-old boy is sent to paediatric consultation for nightrecurring abdominal pain of 3 weeks duration. Clinical examination reveals a moderate pain to deep palpation of the right iliac fossa. The rest of the clinical examination is unremarkable. Ultrasound (US) shows a slightly swollen 7 mm transverse diameter appendix, electively sensitive. Swelling is the result of hypoechogenic submucosal layer thickening, attributed to lymphoid hyperplasia of the appendicular walls (Fig. A, black arrows). In addition, the mean portion of the appendix appears intussuscepted in its distal portion (Fig. A, white arrows) and made protrusion in the cecum, generating a target image (Fig. B). The proximal portion of the appendix is nodular and the end portion is normal (Fig. A). The ileocecal valve is well individualized and is normal. Blood biology proves to be normal. US performed 10 days later finds the same aspect. Due to the persistence of symptoms, surgery by laparoscopy is performed. The surgeon confirms intussusception but feared the presence of anappendiceal tumor on the basis of the swollen and appendix nodular aspect. Histological analysis finds important lymphoid hyperplasia of the appendiceal wall. No tumor process is found (Fig. C). Operating suites are uneventful and painful symptoms disappeared completely.