Ileocecal intussusception in the adult population: case series of two patients.
BACKGROUND
Intussusception is a condition found primarily in the pediatric population. In the adult population, however, intussusception is usually due to a pathological process, with a higher risk of bowel obstruction, vascular compromise, inflammatory changes, ischemia, and necrosis. Radiographic and sonographic evidence can aid in the diagnosis. Surgical intervention involving resection of affected bowel is the standard of care in adult cases of intussusception.


METHODS
We present the case of a 21-year-old female who presented to the Emergency Department with diffuse cramping abdominal pain and distention. Workup revealed ileocecal intussusception, with a prior appendectomy scar serving as the lead point discovered during exploratory laparotomy. We also present the case of a 66-year-old male, who presented with one week of intermittent lower abdominal pain associated with several episodes of nausea and vomiting. Workup revealed ileocolic intussusception secondary to adenocarcinoma of the right colon, confirmed upon exploratory laparotomy with subsequent right hemicolectomy.


CONCLUSIONS
In the adult population, intussusception is usually caused by a lead point, with subsequent telescoping of one part of the bowel into an adjacent segment. While intussusception can occur in any part of the bowel, it usually occurs between a freely moving segment and either a retroperitoneal or an adhesion-fixed segment. The etiology may be associated with pathological processes such as carcinoma or iatrogenic causes, such as scars or adhesions from prior surgeries. The cases presented here demonstrate important etiologies of abdominal pain in adult patients. Along with gynecological etiologies of lower quadrant abdominal pain in female patients, it is important for the emergency physician to expand the differential diagnosis to include other causes, such as intussusceptions, especially given the symptoms that could be associated with bowel obstruction.
Ibrahim
Deena
D
University of California, Irvine, Department of Emergency Medicine, Irvine, CA.
Patel
Nina P
NP
Gupta
Malkeet
M
Fox
J Christian
JC
Lotfipour
Shahram
S
World J Gastroenterol. 2009 Jan 28;15(4):407-11
19152443
Ann Radiol (Paris). 1996;39(4-5):213-6
9637088
Ann Surg. 1970 Aug;172(2):306-10
5433296
Clin Radiol. 2005 Jan;60(1):39-46
15642291
Radiology. 1999 Sep;212(3):853-60
10478257
Clin Radiol. 1998 Jan;53(1):53-7
9464437
Radiology. 1977 Sep;124(3):791-2
887775
Am Surg. 1994 Dec;60(12):980-1
7992979
World J Emerg Surg. 2008 Aug 04;3:26
18680588
Gastrointest Radiol. 1991 Summer;16(3):264-6
1879648
Am J Surg. 1997 Feb;173(2):88-94
9074370
J Clin Ultrasound. 2002 Jan;30(1):48-51
11807856
Ann Surg. 1997 Aug;226(2):134-8
9296505
Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi. 1995 May-Jun;36(3):170-5
7618466
J Clin Gastroenterol. 2003 Jan;36(1):18-21
12488701
Am J Gastroenterol. 1993 Apr;88(4):617-8
8470658
Int J Colorectal Dis. 2004 Jan;19(1):68-72
12838363
Am J Surg. 1961 Jan;101:114-20
13695859
J Pediatr. 1998 May;132(5):836-9
9602196
Am J Surg. 2003 Jul;186(1):75-6
12842754
Acta Chir Belg. 1997 Aug;97(4):190-1
9381902
Ann Surg. 1981 Feb;193(2):230-6
7469558
Am J Surg. 1971 May;121(5):531-5
5557762
Radiographics. 1999 Mar-Apr;19(2):299-319
10194781
Abdom Imaging. 2000 Jan-Feb;25(1):45-7
10652920
J Am Coll Surg. 1999 Apr;188(4):390-5
10195723
Pediatr Emerg Care. 1992 Dec;8(6):325-7
1454638
ANZ J Surg. 2003 Dec;73(12):1044-7
14632903