Crohn’s disease triggering ileoileal intussusception in an adult

Intussusception is defined as the telescoping of a segment of the gastrointestinal tract (intussusceptum) into an immediately adjacent distal bowel (intussuscipiens), causing venous congestion, edema, and blood supply reduction. Adult intussusception is a rare entity which can be with or without lead-point. Cases without lead-point frequently occurs in children or adults with celiac disease and Crohn’s disease and with lead point is caused by an underlying neoplasm, benign or malignant frequently presenting with bowel obstruction and acute abdomen. A 41-years-old male presented to our outpatient clinic with a history of recurrent abdominal pain. The clinical presentation and CT scan findings led to the diagnosis of ileoileal intussusception. Subsequently he underwent laparotomy which revealed an ileal intussusception, which was investigated and was found to be of Crohn’s etiology.

Small Bowel Intussusception due to Multiple Intestinal Metastases from Lung Adenocarcinoma

Metastatic small bowel tumors are rare. They often present with small bowel occlusion, bleeding, perforation, or intestinal intussusception. Pulmonary adenocarcinoma with metastasis to the small intestine causing intussusception is exceedingly rare. A 72-yearold male patient with a past medical history of left lung adenocarcinoma, presented to the emergency department with abdominal pain and vomiting. On admission, an X-ray of the abdomen without preparation showed some hydroaeric levels on the small intestine. The abdominopelvic computed tomography (CT) scan revealed an ileo-ileal invagination, with an image of the invagination rod. The patient underwent a surgical resection of the small bowel with the removal of the ischemic areas and immediate anastomosis. Macroscopic examination of the surgical specimen revealed five tumor masses varying in size between 1 and 4 cm. The histological examination of the samples taken from these tumors, coupled with an immunohistochemical study confirmed the diagnosis of intestinal metastases of pulmonary origin expressing cytokeratin 7 (CK7) and thyroid transcription factor 1 (TTF1) but negative for CK20, chromogranin, and synaptophysin. The postoperative course was uneventful, and the symptoms transiently recovered. However, the patient died 3 months later. We should consider multiple metastatic lesions in adult intussusception, especially in patients with a past medical history of lung cancer.

Intraoperative Endoscopy in Transient Adult Jejunojejunal Intussusception

Despite improvements in imaging modalities, causative lead points in adult intussusception may be difficult to diagnose. Such lead points can be malignant, causing recurrence or metastases if left unresected. We describe a case of transient adult jejunojejunal intussusception, in which intraoperative endoscopy was used to confirm the absence of a lead point. A 39-year-old woman with a history of laparoscopic oophorectomy presented with epigastric pain, nausea, and vomiting. Contrast computed tomography revealed jejunojejunal intussusception, with no visible lead point. Spontaneous reduction was confirmed during exploratory laparoscopy. After lysis of adhesions, intraoperative peroral jejunoscopy was performed with the surgeons’ assistance. Endoscopy confirmed the absence of tumor, and bowel resection was avoided. No recurrence has been observed during 24 months of follow-up. Intraoperative endoscopy may provide additional reassurance for the absence of a lead point in cases where preoperative enteroscopy cannot be performed and no lead points can be identified on imaging.

Jejunojejunal intussusception in an adult: a rare presentation of abdominal pain in the emergency department

Abdominal pain is a common presentation to the emergency department (ED) and the differential diagnoses is broad. Intussusception is more common in children, with only 5% of cases reported in adults. 80%–90% of adult intussusception is due to a well-defined lesion resulting in a lead point, whereas in children, most cases are idiopathic. The most common site of involvement in adults is the small bowel. Treatment in adults is generally operative management whereas in children, a more conservative approach is taken with non-operative reduction. We present a case of a 54-year-old woman who presented to our ED with severe abdominal pain and vomiting. CT of the abdomen revealed a jejunojejunal intussusception. The patient had an urgent laparoscopy and small bowel resection of the intussusception segment was performed. Histopathological examination of the resected specimen found no pathologic lead point and, therefore, the intussusception was determined to be idiopathic.

Jejuno-jejunal intussusception in an adult – a rare presentation of abdominal pain in the Emergency Department

Background Abdominal pain is a common presentation to the emergency department (ED) and the differential diagnoses is broad. Intussusception is a more common diagnosis in children, with only 5% of cases reported in adults. 80–90% of adult intussusception is due to a well-defined lesion resulting in a lead point, whereas in children, most cases are idiopathic. Adult intussusception is also more commonly associated with malignancy, compared to children. In adults, malignancy is more common in intussusception involving the large bowel compared to intussusception in the small bowel. Case presentation We present a case of a 54-year-old lady who presented to our ED with abdominal pain and vomiting. She had multiple abdominal surgeries in the past. On examination, she had epigastric and peri-umblical tenderness. In view of her persistent abdominal pain that was refractory to analgesia, she had computed tomography (CT) of the abdomen which revealed a jejuno-jejunal intussusception and proximal small bowel obstruction. The patient had an urgent laparoscopy and small bowel resection of the intussusception segment was performed. No pathological lead point was identified on imaging or intra-operatively. The patient made a full recovery post operatively. Conclusion Our case report illustrates a rare diagnosis of abdominal pain and vomiting, presenting to the Emergency Department. With increasing accessibility to CT, most cases of adult intussusception are found incidentally on contrast CT of the abdomen and pelvis. While there is no consensus on management, it is more common for adult intussusception patients to have operative intervention, compared to childhood intussusception.

3D Laparoscopy-Assisted Operation to Adult Intussusceptions During Perioperative Period of Liver Transplantation: Case Report and Literature Review

Adult intussusception during the perioperative period is defined as an extremely rare condition, especially when it emerges within short intervals of laparotomy, which may be explained as an unphysiological peristaltic function of the bowel without any lead points. Accurate diagnosis and therapeutic schedule predict a satisfactory outcome. Here, we introduce the case of a 32-year-old man who had symptoms of abdominal pain, no gas emission, and defecation shortly after liver transplantation. Intussusception was definitely diagnosed by abdominal CT, and then reduction was operated successfully by three-dimensional laparoscopy-assisted operation. There were no other complaints, and no secondary lesions were detected during the postoperative rehabilitation process in the hospital and over a follow-up period of 6 months. Relevant literature has been summarized subsequently. A promising minimally invasive surgery along with minimal secondary trauma was presented by laparoscopy in this rare case, providing the potential remedy for perioperative intussusception in the adult.

Adult Intestinal Intussusception Caused by the Gastrojejunostomy Tube: An Endoscopically Treatable Phenomenon

Adult duodenoduodenal intussusception is extremely rare due to the retroperitoneal fixation of the second, third, and fourth parts of the duodenum. A majority of clinically significant intussusception with identifiable etiologies is typically neoplastic with more rare causes including retained food and indwelling enteral tubes, specifically with gastrojejunostomy (GJ) tubes. Herein, we discuss the case of a 23-year-old male who developed duodenoduodenal intussusception upon a PEGJ placement with associated gastroduodenal dilation and telescope phenomenon. To the best of our knowledge, there are no reports of intussusception found to be caused by GJ tubes in the adult population. The reported patient was found to have a 4-cm enteroenteric intussusception without obstruction or ischemia with bowel thickening proximal to the pathology. Although adult intussusception cases are typically managed surgically, we were able to reduce the intussusception via endoscopy due to rapid diagnosis upon presentation and intervention before the bowel wall could be compromised.