ADULT INTUSSUSCEPTION

ABSTRACT

BACKGROUND

Intussusception is the invagination of a segment of the gastrointestinal tract into the lumen of an adjacent segment. It is a rare cause of intestinal obstruction in adults and poses a diagnostic dilemma when present.

CASE PRESENTATION

This is a report of a sixty year-old male who presented to the Emergency Department of The University College Hospital, Ibadan, Nigeria with peri-umbilical pain of one week duration and inability to pass faeces for five days. There was a palpable abdominal mass. Abdominal ultrasonography showed features of intestinal obstruction and exploratory laparotomy revealed an ileo-ileal intussusception. Milking was attempted and was partially successful. The intussuscepted bowel loops were resected followed by an end-to-end anastomosis.

DISCUSSION

Intussusception remains an uncommon condition representing 1-5% of cases of bowel obstruction and accounting for 0.003-0.02% of hospital admissions. It occurs in the small bowel in 50-80% of cases. Unlike the typical presentation in children which is acute in onset with episodic abdominal pain, currant jelly stools and vomiting, presentation in adults is often with a vague history of symptoms that might include diarrhoea, constipation and weight loss. The aetiology can be idiopathic or pathological, with pathologic causes occurring in 80% of cases. These include malignancy, inflammatory and benign intestinal lesions that serve as a lead point which can trigger intussusception. Several imaging modalities can be used to obtain diagnosis, however, an Abdominal Computed Tomography is the gold standard. Despite its use, accurate pre-operative diagnosis is low with most cases diagnosed during emergency laparotomy. The therapeutic strategy requires a patient-tailored approach. Surgical resection is the definitive treatment.

CONCLUSION

Adult intussusception is uncommon and requires a high index of suspicion to reach an accurate pre-operative diagnosis. An underlying pathology is present in majority of cases. Surgery is the definitive treatment.

KEYWORDS: Adult Intussusception, Abdominal Computed Tomography, Ibadan.