Adult intussusception: A case report and review of literature of a patient seen at university of Abuja teaching hospital, Gwagwalada, Abuja, Nigeria

Abstract

Intussusception is a recognized cause of bowel obstruction and is significantly more common in paediatric patients. Adult intussusception is rare and usually results from a predisposing factor in most patients. These factors may include benign lesions, malignant lesions, or bowel wall abnormalities such as inflammatory bowel disease. We report on a case of a patient who presented with recurrent colicky central abdominal pain, anorexia, vomiting with occasional constipation and diarrhoea for six months. She was assessed and investigated with abdominal USS and Computer Tomography (CT) Scan, which showed features of intussusception, with telescoping of the jejunum with proximal bowel distension suggesting bowel obstruction. The patient underwent emergency laparotomy and surgical resection, and histopathology confirmed the lead point as intraluminal lipoma.

We present a case of jejuno-jejunal intussusception in an adult, which is not commonly seen. The history of recurrent colicky abdominal pain and CT abdomen, together with an abdominal ultrasound scan (USS), was important in establishing a preoperative diagnosis, and histology confirmed lipoma as a lead point. Despite the conservative approach described in the literature, surgery continues to be the only option in patients who are unstable with persistent colicky abdominal pain, vomiting, abdominal distension, and constipation; Surgery is advocated for all adult patients. Adult intussusception is not a common condition and can be difficult to diagnose, posing a diagnostic conundrum. Patients with intussusception may report a relatively long period of recurrent colicky abdominal pain that might worsen acutely following complete obstruction. Abdominal CT scan is a very useful investigation in the preoperative diagnosis of intussusception, with histopathological confirmation of lipoma as a lead point.