Case report of a rare variant of adult intussusception with delayed presentation: idiopathic ileocecal colic intussusception

Abstract

Introduction: Adult intussusception is rare, occurring in only 1 out of 1300 (0.08%) abdominal surgeries and accounting <1% of adult intestinal obstruction cases. The overall incidence of adult intussusception is 1-3 cases per 100 000 population and comprises 5% of all intussusception cases. Idiopathic ileocecal colic intussusception in adults is exceptionally rare, making our case a unique and noteworthy contribution to the existing literature.

Case presentation: A 23-year-old male presented with abdominal pain for 2 weeks, associated with vomiting and black-colored stool. On examination, mild tenderness and a palpable mass were noted over the right lumbar region. Ultrasonography and Contrast Enhanced Computed Tomography (CECT) of the abdomen and pelvis revealed features of ileocecal colic intussusception. An emergency exploratory laparotomy was performed, with reduction of the intussusceptum using the Hutchinson maneuver, followed by a limited right hemicolectomy.

Discussion: Although intussusception is the most common cause of bowel obstruction in children aged ≤5 years, it is rare in adults. When it does occur in adults, >90% of cases are associated with an identifiable lead point, with only a few cases being idiopathic. The most commonly reported types of intussusception in adults are colocolic and enteric, followed by ileocolic and ileocecal types.

Conclusion: Acute intestinal obstruction is not the typical presentation of adult intussusception; rather, the majority of cases present with subacute or chronic symptoms. History of recurrent intermittent partial bowel obstruction over days to years may suggest intussusception. Early diagnosis and timely intervention can significantly reduce patient morbidity and mortality.

Keywords: adult; case report; idiopathic; ileocecal colic; ileocolic; intussusception.

Figure 1.

CECT abdomen axial view showing bowel within bowel appearance (target sign) with parts of intussusception. Blue arrow showing intussusceptum and white arrow showing intussuscipiens with thickened wall.

Figure 2.

CECT abdomen coronal and sagittal view showing terminal and ileocecal junction (white arrow) intussuscepting into edematous and thickened ascending colon (green arrow).

Figure 3.

Intraoperative view showing terminal ileum (blue arrow) telescoping into ascending colon (green arrow).

Figure 4.

Intraoperative view showing gangrenous part of caecum (green arrow) with appendix (white arrow) after reduction of intussusceptum by Hutchinson maneuver.