Adult Intussusception: Delayed Presentation and Review CM Watson MD and SA Fann MD USC School of Medicine, Columbia, South Carolina

1
Adult Intussusception Delayed Presentation and
ReviewCM Watson MD and SA Fann MDUSC School of
Medicine, Columbia, South Carolina
Presentation
Hospital Course
Treatment
A 40-year-old woman was admitted to the emergency
room with complaints of mild, crampy, abdominal
pain, nausea, and obstipation. She was afebrile
and vitals signs were within normal limits.
Physical exam demonstrated mild abdominal
distension and pain. White blood cell count was
10.1 cells/µL with 94 neutrophils on
differential. All other labs were relatively
normal. Initial imaging included an abdominal
radiograph, shown in Figure 1.
She was followed on the surgical ward with serial
abdominal examinations. On hospital day 2, her
WBC count rose to 12.1 cells/µL with 9 bands on
the differential. In addition, her temperature
peaked at 101.2. Her abdominal exam worsened
therefore an abdominal computed tomographic study
was performed with intravenous and oral contrast.
A selected image is shown in Figures 2. The
initial report was read by a radiologist as
negative but a second review reported proximal
small bowel intussusception with obstruction and
mild inflammatory changes of the involved
mesentery. Additional findings included a right
ovarian dermoid cyst and free fluid in the
cul-de-sac.
She subsequently underwent exploratory laparotomy
for planned resection of the involved small
bowel, as well as a right salpingoopherectomy.
Intraoperative findings are shown in Figures 3
and 4. Pathologic evaluation revealed a benign
polyp as the lead point, shown in Figure 5. The
ovarian mass was discovered to be a mature cystic
teratoma.
Result
She did well and was discharged home with
resolution of her preoperative symptoms.
Figure 3. Intraoperative View.
Discussion

• Adults account for only 5 of cases
• Transient symptoms may be present for months or
  years before medical attention is sought.
• Diagnosis is difficult even with available
  imaging modalities.
• Treatment should be early, and for most adults,
  should include resection because of the high
  incidence of malignant lead points.
• Post-traumatic intussusceptions may be followed
  for resolution with surgery reserved for those
  who worsen. Even so, some may attempt reduction
  prior to resection in this population.
• Gastroduodenal intussusceptions should be treated
  with reduction and resection of the lead point
  only.
• Coloanal intussusceptions should be reduced prior
  to resection in an attempt to avoid
  abdominoperineal reconstruction.

Figure 1. Upright abdominal radiograph.
Figure 2. CT of the Abdomen
Figure 4. View of the Intussusceptum and
Intussuscipiens
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Figure 5. Pathologic Specimen.