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An acute abdomen pain
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  1. Rakesh Biswas1,
  2. Omar Irfan1,
  3. Manoj Sharma1,
  4. Gyanendra Khare1,
  5. Rajesh Gupta2,
  6. Suraj Jain3,
  7. Navneet Mishra4
  1. 1
    People’s College of Medical Sciences, Medicine, Bhanpur Bypass Road, Bhopal, 462010, India
  2. 2
    People’s College of Medical Sciences, Radiology, Bhanpur Bypass road, Bhopal, 462010, India
  3. 3
    People’s College of Medical Sciences, Bhanpur Bypass Road, Bhopal, 462010, India
  4. 4
    People’s College of Medical Sciences, Surgery, Bhanpur Bypass Road, Bhopal, 462010, India
  1. rakesh7biswas{at}gmail.com

https://doi.org/10.1136/bcr.08.2008.0839

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    DESCRIPTION

    A 61-year-old retired farmer started experiencing severe pain in his abdomen for the last 2 weeks along with abdominal distension, vomiting and inability to pass flatus or faeces. He was investigated on admission to our casualty and an abdominal x ray revealed classical features of intestinal obstruction (fig 1). A CT of the abdomen done subsequently confirmed the diagnosis (fig 2).

    Figure 2
    Figure 2

    Contrast-enhanced transverse CT scan of the abdomen shows an ileo-ileal intussusception. Straight arrow shows the leading edge of the protruding ileal loop with mesenteric fat. Curved arrows show the proximal dilated fluid-filled small bowel loops.

    He was operated on and an intestinal resection anastomosis was done. The histopathology confirmed the radiological diagnosis (fig 3).

    Figure 3
    Figure 3

    A labelled, still image of the resected bowel histopathology.

    Intussusception occurs when one segment of the proximal bowel telescopes into the lumen of an adjacent distal segment of the bowel resulting in obstruction and possibly ischaemic injury and death of the affected segment of the bowel. Only about 5% of all cases of intussusception are thought to occur in adults.1 Abdominal CT is the most accurate diagnostic procedure, revealing intussusception in 78% of cases.2

    Many case reports show unusual associations of intussusception with other conditions, such as Meckel diverticulum, Crohn’s disease, postoperative recovery, coeliac disease and local inflammation resulting from pancreatitis.3

    The most common benign cause of enteric intussusception is postoperative adhesions. Malignancy is more commonly associated with colonic intussusception than with enteric intussusception. Among adults, idiopathic enteric intussusception appears to be more common than idiopathic colonic intussusception.

    Surgical resection without reduction is generally advocated as the best treatment for adults with intussusception.

    Acknowledgments

    To all the caregivers associated with this patient.

    REFERENCES

    1. ↵
      1. Afgha FP
      . Intussusception in adults. AJR Am J Roentgenol 1986; 146: 527–31.
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    2. ↵
      1. Huang BY,
      2. Warshauer DM
      . Adult intussusception: diagnosis and clinical relevance. Radiol Clin North Am 2003; 41: 1137–51.
      OpenUrlCrossRefPubMedWeb of Science
    3. ↵
      1. Albright MT,
      2. Grief SN,
      3. Carroll RE,
      4. et al
      . Ileoileal intussusception in an adult patient. Can Fam Physician 2007; 53: 241–3.
      OpenUrlFREE Full Text

    Footnotes

    • Competing interests: none.

    • Patient consent: Patient/guardian consent was obtained for publication.