Idiopathic Postpartum Intussusception: A Rare Cause of Acute Abdominal Pain

Abstract

Objectives: To present a case with acute abdominal pain due to idiopathic intestinal intussusception diagnosed by ultrasound and computed tomography (CT) during the early postpartum period. Clinical Presentation and Intervention: A 21-year-old female patient was admitted to our hospital with abdominal pain, nausea and emesis after a normal vaginal delivery. Laboratory tests done at admission were within normal limits except for leukocytosis. Physical examination revealed abdominal distention, guarding and rebound tenderness. Abdominal ultrasound and oral contrast-enhanced CT showed a complex mass in the hypogastrium, with a typical configuration of intussusception. Emergent laparotomy revealed ileoileal invagination approximately 70 cm to the ileocecal valve but no lead point. A partial ileal resection was performed. Conclusion: This case shows that when intussusception is suspected, an abdominal ultrasound should be performed even in patients with atypical symptoms. CT may be used to confirm the diagnosis.

Total duodenal necrosis with retroperitoneal perforation in an adolescent with jejunal intussusceptions

“…In the case of early invagination without pathological changes in intestinal wall, de‐intussusception can be sufficient. If, however, there is a risk of bowel infarction or obstruction results from its pathology, the resection of the involved bowel segment is necessary . In the case described above, the obstruction of the proximal jejunum resulting from intussusception was the probable cause of duodenal ischemia.…”

“…Sometimes a milder course of partial obstruction is observed. Approximately half patients with jejunal invagination can be diagnosed based on their clinical manifestations alone, while others usually have non‐specific symptoms …”

Postpartum acute abdomen and its diagnostic challenges

“…In 2013, however, a 40-year-old primigravida presented similarly day 3 postpartum, with prominent bowel loops on X-ray, however, she was thought to have constipation until bilious vomiting prompted a CT, laparotomy and eventual colostomy: less classical findings delayed diagnosis 3. Other cases describe postpartum bowel obstruction in a patient with previous Roux-en-Y gastric bypass,4 and idiopathic and lymphoma-induced intussusception 5 6…”

Small Bowel Obstruction in Postpartum Vaginal Delivery due to Prior Abdominal Adhesions Case Report

“…This usually occurs after Cesarean section [ 5 ], trauma, pelvic surgery, sepsis [ 6 ], and a few cases of vaginal delivery [ 7 ]. Idiopathic intussusception has also been reported during the postpartum period following vaginal delivery [ 8 ]. Curiously, intestinal ileus is common in other mammals including intestinal pseudo-obstruction observed in lactating mice in the second week postpartum [ 9 , 10 ] and also in postpartum mares [ 11 ].…”