Idiopathic adult intestinal intussusception: a rare cause of an acute surgical abdomen

Abstract

Intussusception is uncommon among adults. The condition, which is defined as a telescoping of a proximal portion of the small or large bowel into the lumen of an adjacent segment of bowel, is most commonly seen in children. Among pediatric cases, the majority is benign and treated non-operatively. However, in adults, intussusception is the result of pathologic and often malignant lead points in the majority of cases. This makes surgical resection and tissue diagnosis the only definitive treatment option. While the majority of adult intussusception cases involves a pathologic lead point, a small percentage is idiopathic, without an identifiable lead point. We present a 32-year-old man with acute on chronic abdominal pain and cross-sectional imaging that identified jejunal intussusception, which was confirmed in operating room and resected. Interestingly, no pathologic lead point was identified on pathologic review. We discuss our diagnostic approach, surgical decision making and final tissue diagnosis.

Figure 1

A. CT abdomen axial view showing the ‘Target Sign’ present within the small bowel; B. CT abdomen coronal view showing invagination of a proximal portion of small bowel into the adjacent section of bowel; C. CT abdomen sagittal view showing the aforementioned invagination of small bowel.

Figure 2

Intra-operative laparoscopic view of the intussuscepted small bowel prior to resection.

Figure 3

Gross resection specimen.