Adult Intussusception: Delayed Presentation and Review
CM Watson MD and SA Fann MD
USC School of Medicine, Columbia, South Carolina
Presentation
Hospital Course
Treatment
A 40-year-old woman was admitted to the emergency
room with complaints of mild, crampy, abdominal pain,
nausea, and obstipation. She was afebrile and vitals
signs were within normal limits. Physical exam
demonstrated mild abdominal distension and pain.
White blood cell count was 10.1 cells/µL with 94%
neutrophils on differential. All other labs were relatively
normal. Initial imaging included an abdominal
radiograph, shown in Figure 1.
She was followed on the surgical ward with serial
abdominal examinations. On hospital day 2, her WBC
count rose to 12.1 cells/µL with 9% bands on the
differential. In addition, her temperature peaked at
101.2. Her abdominal exam worsened therefore an
abdominal computed tomographic study was performed
with intravenous and oral contrast. A selected image is
shown in Figures 2. The initial report was read by a
radiologist as negative but a second review reported
proximal small bowel intussusception with obstruction
and mild inflammatory changes of the involved
mesentery. Additional findings included a right ovarian
dermoid cyst and free fluid in the cul-de-sac.
She subsequently underwent exploratory laparotomy for
planned resection of the involved small bowel, as well as
a right salpingoopherectomy. Intraoperative findings
are shown in Figures 3 and 4. Pathologic evaluation
revealed a benign polyp as the lead point, shown in
Figure 5. The ovarian mass was discovered to be a
mature cystic teratoma.
Result
She did well and was discharged home with resolution of
her preoperative symptoms.
Figure 3. Intraoperative View.
Discussion
•Adults account for only 5% of cases
•Transient symptoms may be present for months or
years before medical attention is sought.
•Diagnosis is difficult even with available imaging
modalities.
•Treatment should be early, and for most adults, should
include resection because of the high incidence of
malignant lead points.
•Post-traumatic intussusceptions may be followed for
resolution with surgery reserved for those who worsen.
Even so, some may attempt reduction prior to resection
in this population.
•Gastroduodenal intussusceptions should be treated
with reduction and resection of the lead point only.
Figure 1. Upright abdominal radiograph.
•Coloanal intussusceptions should be reduced prior to
resection in an attempt to avoid abdominoperineal
reconstruction.
Figure 2. CT of the Abdomen
Figure 4. View of the Intussusceptum and Intussuscipiens
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Figure 5. Pathologic Specimen.