A Surprising Case Of Adult Intussusception In A Patient With Prior Ileocolic Anastomosis
INTRODUCTION: Intussusception is defined as the telescoping of a proximal segment of bowel into a distal segment. Intussusception is the second leading cause of acute abdomen in children, but it only represents approximately 5% of all bowel obstructions in adults. Furthermore, adult intussusception accounts for only 5% of all cases of bowel obstruction. In pediatrics intussusception is usually primary, while intussusception in adults are usually secondary to neoplasm.
CASE REPORT: Our patient was a 68-year-old male with a past medical history of Crohn's disease treated with open ileocecectomy over 30 years prior, who presented to the outpatient clinic with worsening malnutrition and electrolyte imbalances. The patient exhibited limited symptoms of chronic obstruction and pre-operative imaging showed dilated loops of small bowel with wall thickening at the site of the ileocolic anastomosis, thought to be due to stricture. The patient was consented for laparoscopic ileocolic resection. Upon visualization of the small bowel it was found that the proximal portion of the ileocolic anastomosis had intussuscepted into the distal colon. The portion of the intussusception was surgically removed and the remaining portions of the small bowel and colon were anastomosed. The patient had no evidence of active Crohn's disease.
CONCLUSION: Intussusception is a rare cause of small bowel obstruction in the adult population and is a challenging preoperative diagnosis to make because symptoms are nonspecific. However, physicians should always consider the possibility of intussusception when non-specific obstructive and malnutrition symptoms are present, even when not evident on pre-operative imaging.