Idiopathic adult ileoileal and ileocolic intussusception in situs inversus totalis: a rare coincidence

Abstract

Situs inversus totalis is a rare autosomal recessive congenital anomaly that is characterized by mirror image anatomy of the abdominal and thoracic organs. We report a case of a 28-year-old male with situs inversus totalis, who developed an idiopathic ileoileal and ileocolic intussusception, which was diagnosed on computed tomography scan. Patient underwent successfully ileal resection and side-to-side functional anastomosis of ileum 12 cms from ileocecal junction. Postoperative course was uneventful. To the best of our knowledge, this is the first case of idiopathic adult intussusception with situs inversus totalis in the literature.

Figure 1

Contrast-enhanced CT scan of the abdomen demonstrated situs inversus totalis with apex of the heart, stomach and spleen resting on the right side and the liver on the left side of the abdomen and ileocolic intussusception which creates characteristic bowel-within-bowel appearance, seen in left iliac fossa (white arrow)

Figure 2

Contrast-enhanced CT scan of the abdomen demonstrated the classic findings of a target like an ileocolic intussusception, with no evidence of proximal bowel obstruction in situs inversus totalis (white arrow)

Figure 3

The resected ileum specimen shows inflammatory pseudo polyps (black arrow)

Figure 4

Histopathology showing inflammatory pseudopolyps projecting above the mucosal surface composed of inflamed granulation tissue with surface ulceration and dilated and hyperplasic crypts