Case Report: A Closed Loop Obstruction Secondary to Idiopathic Small Bowel Intussusception in an Elderly Woman

Abstract

Intussusception is primarily a disease of children and is the primary cause of intestinal obstruction in the pediatric age group. It accounts for around 5–16% of cases of intestinal obstruction in adults of the western population. Most cases of adult intussusception (up to 90%) are secondary to an identified structural lesion or a lead point contrary to pediatric intussusception. Adults with intussusception present with subacute or chronic symptoms of partial obstruction. CT is the best imaging to make a preoperative diagnosis of adult intussusception. The standard treatment for adult intussusception is surgery, and non-operative reduction should not be attempted. Here, we present a rare case of idiopathic small bowel intussusception in a 50-year-old woman. She presented with crampy abdominal pain for one-week duration. It was associated with frequent vomiting of bilious matter. She claimed to have had similar symptoms for the past 2 months and had repeatedly visited nearby health facilities. She had an abdominal CT, which suggested a complicated small bowel intussusception. Exploratory laparotomy was done, and there was a small bowel intussusception and an inflammatory stricture at the end of the intussusceptum, which is believed to form a closed-loop like obstruction. The intussusceptum was resected en-bloc then end-to-end jejuno-jejunal anastomosis was performed. This case report makes physicians aware of this rare condition in adults. So that they have a high index of suspicion when a patient presents with symptoms of subacute or chronic intestinal obstruction and inform that abdominal CT should be done in these circumstances and surgery is the mainstay of treatment. Our case is unique, and there is no report in the literature similar to ours.

A Non-operative Approach of Small Bowel Obstruction in Virgin Abdomens

“…Similar to our patient in this report, the majority of SBO-VA happens to be happening in the male population (66.7%) [2] compared to the female population. The median age [2] in years of occurrence happens to be 58 years but the range is between 23 and 101.…”

“…Among them include adhesions (being the most common), internal herniation, intussusception, gallstone ileus, phytobezoar, newly diagnosed small bowel tumour, stricture, Meckel's diverticulum and mesenteric volvulus [ 1 ]. Similar to our patient in this report, the majority of SBO-VA happens to be happening in the male population (66.7%) [ 2 ] compared to the female population. The median age [ 2 ] in years of occurrence happens to be 58 years but the range is between 23 and 101.…”

“…This is in the background thought of contemplating a possible malignant aetiology or a more complicated/catastrophic aetiology compared to someone who has undergone previous abdominal operations. However, the latest research [ 2 ] has seemed to shift from this dogma. Unfortunately, up to date, no concrete study is present to confirm that foregoing operative management in patients with no prior operative history is not harmful.…”