Idiopathic Ileo-Ileo-Cecal Intussuception in a 25-Year-Old Female

Abstract

Patient: Female, 25 Final Diagnosis: Leo-ileo-cecal intussuception Symptoms: Abdominal pain Medication: — Clinical Procedure: — Specialty: Surgery Objective: Rare disease Background: Intussusception is defined as the penetration or telescoping of a segment of bowel into a more distal segment. Intussusception is a common cause of small bowel obstruction, especially in children. However, this finding is much less common in adults. Furthermore, when present in adults, intussusception is often found in association with some sort of organic mass, such as a tumor or pancreatic divisum that acts as a lead point, dragging the proximal segment into the distal one. The presence of an intussusception in an adult patient with no obvious lead point is very uncommon. Case report: Here we report a case of ileo-ileo-cecal double intussusception in an adult patient that yielded no lead point on surgical exploration. The patient was a 25-year-old female who presented with symptoms of obstruction and was diagnosed with the intussusception via computed tomography scan. Surgical resection of the bowel was necessary as reduction could not be accomplished. Conclusions: The finding of intussusception in an adult patient is far less common than in children, and even more rare when a lead point is not established. When surgery is required, a thorough exploration should be performed to search any signs of a potential lead point. Laparoscopy is usually preferred to laparotomy; however, in this case the degree of distention determined the surgical approach. Thus, due to severe distention, laparotomy was preferred.

Intestinal Intussusception: A Shocking Diagnosis

“…It is a challenging diagnosis, resulting in important morbidity and mortality due to delayed diagnosis [ 1 ]. The first described case was reported in 1674 by Paul Barbette, but throughout history, there have been other reports of intussusceptions [ 2 , 3 ].…”

“…According to the literature, in 90% of adult intussusception cases, a pathologic cause is identified [ 2 ], such as a tumor, pancreas divisum, polyps, a Meckel diverticulum, or mesenteric cysts [ 5 ], among others.…”

“…Any segment of the gastrointestinal tract can be involved [ 4 ], but there are some portions where a more freely mobile segment can go through a fixed one, due to adhesions or for its retroperitoneal location [ 4 ]. Therefore, most of these intussusceptions [ 2 ] tend to occur within the bowel (small or large). The ileum is the most frequent location (ileoileal intussusceptions are the most common, and double ileoileal or ileocecal are the less frequent), and only roughly 10% occur in extraintestinal locations [ 2 ].…”

“…Therefore, most of these intussusceptions [ 2 ] tend to occur within the bowel (small or large). The ileum is the most frequent location (ileoileal intussusceptions are the most common, and double ileoileal or ileocecal are the less frequent), and only roughly 10% occur in extraintestinal locations [ 2 ].…”

“…Abdominal pain is the most common presenting symptom, followed by changes in regular bowel habits, nausea, vomiting, and gastrointestinal bleeding [ 6 ]. If not promptly diagnosed, intestinal intussusception may result in serious complications such as bowel obstruction or even strangulation and ischemia [ 2 ].…”