ADULT INTUSSUSCEPTION: FINDING A LEAD ON A RARE CASE P Cacioppo MD, HH Hajebian MD Department of Medicine, Ochsner Medical Center, New Orleans, LA
INTRODUCTION Bowel intussusception is a defined as a telescoping proximal loop within the distal loop of bowel, obliterating the bowel lumen. Although over 95% of cases occur in the pediatric population; intussusception in adults is strongly associated with tumors, with malignancy rates accounting for approximately half of all adult cases.
CASE: A 37-year-old female with no past medical history presents complaining of suddenly worsening non-localized abdominal pain and distension. The patient reports a 5-day history of intermittent generalized crampy abdominal pain, which causes her to wake up several times throughout the night, associated with anorexia, non-bloody emesis, and constipation followed by small volume, loose stools. Laboratory work-up revealed low bicarbonate and hyponatremia. Computed Tomography of the abdomen with contrast demonstrated a large colonic intussusception from the ascending colon to the splenic flexure, with suggestion of a large polyp or mass in the splenic flexure as a possible lead point. The patient underwent an exploratory laparotomy with right hemicolectomy and lymphadenectomy. Pathology revealed a plasmablastic neoplasm involving the ileocecal valve. All surgical margins and 27 resected lymph nodes were negative. DISCUSSION: Adult intussusception is a rare cause of bowel obstruction that carries a high risk of complications, if not emergently identified and treated. The triad of red currant jelly stool, colicky abdominal pain, and a palpable sausage-shaped mass; classically seen with children, is rarely present in the adult presentation. Due to high rates of malignancy, adult cases are traditionally treated with large en-bloc resection. Early diagnosis of intussusception in adults requires a high level of clinical suspicion; failing may lead to complications such bowel ischemia and perforation.
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