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Ileocecal intussusception in the adult population: case series of two patients.

Ibrahim D, Patel NP, Gupta M, Fox JC, Lotfipour S - West J Emerg Med (2010)

Bottom Line: We also present the case of a 66-year-old male, who presented with one week of intermittent lower abdominal pain associated with several episodes of nausea and vomiting.The etiology may be associated with pathological processes such as carcinoma or iatrogenic causes, such as scars or adhesions from prior surgeries.The cases presented here demonstrate important etiologies of abdominal pain in adult patients.

View Article: PubMed Central - PubMed

Affiliation: University of California, Irvine, Department of Emergency Medicine, Irvine, CA.

ABSTRACT

Background: Intussusception is a condition found primarily in the pediatric population. In the adult population, however, intussusception is usually due to a pathological process, with a higher risk of bowel obstruction, vascular compromise, inflammatory changes, ischemia, and necrosis. Radiographic and sonographic evidence can aid in the diagnosis. Surgical intervention involving resection of affected bowel is the standard of care in adult cases of intussusception.

Case reports: We present the case of a 21-year-old female who presented to the Emergency Department with diffuse cramping abdominal pain and distention. Workup revealed ileocecal intussusception, with a prior appendectomy scar serving as the lead point discovered during exploratory laparotomy. We also present the case of a 66-year-old male, who presented with one week of intermittent lower abdominal pain associated with several episodes of nausea and vomiting. Workup revealed ileocolic intussusception secondary to adenocarcinoma of the right colon, confirmed upon exploratory laparotomy with subsequent right hemicolectomy.

Conclusion: In the adult population, intussusception is usually caused by a lead point, with subsequent telescoping of one part of the bowel into an adjacent segment. While intussusception can occur in any part of the bowel, it usually occurs between a freely moving segment and either a retroperitoneal or an adhesion-fixed segment. The etiology may be associated with pathological processes such as carcinoma or iatrogenic causes, such as scars or adhesions from prior surgeries. The cases presented here demonstrate important etiologies of abdominal pain in adult patients. Along with gynecological etiologies of lower quadrant abdominal pain in female patients, it is important for the emergency physician to expand the differential diagnosis to include other causes, such as intussusceptions, especially given the symptoms that could be associated with bowel obstruction.

No MeSH data available.


Related in: MedlinePlus

Computed Tomography abdomen and pelvis with oral contrast demonstrating target-shaped lesion in the right lower quadrant indicative of ileocecal intussusception.
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f1-wjem-11-197: Computed Tomography abdomen and pelvis with oral contrast demonstrating target-shaped lesion in the right lower quadrant indicative of ileocecal intussusception.

Mentions: The patient’s workup included a white blood cell count of 6.2 thous/mcL (reference range: 4.0–10.5) and elevated liver enzymes with aspartate aminotransferase (AST) of 66 IU/L (reference range: 8–40) and alanine aminotransferase (ALT) of 115 IU/L (reference range: 0–60). Normal total bilirubin was 0.4mg/dL (reference range: 0–1.4) and normal alkaline phosphatase was 50 IU/L (reference range: 26–110). Prothrombin time (PT) and international normalized ratio (INR) were elevated at 15.2 (reference range: 9.6–11.8) and 1.31 (reference range: 0.89–1.11), respectively. Partial thromboplastin time (PTT) was normal at 28.6 (reference range: 24.2–32.6). Urine analysis was negative for urinary tract infection. Urine pregnancy test was negative. Abdominal and pelvic duplex ultrasounds were unremarkable. Computed tomography (CT) scan of abdomen and pelvis showed a target lesion in right lower quadrant with obstruction of contrast and pericolonic fat stranding indicative of intussusception at the ileocecal junction (Figure 1).


Ileocecal intussusception in the adult population: case series of two patients.

Ibrahim D, Patel NP, Gupta M, Fox JC, Lotfipour S - West J Emerg Med (2010)

Computed Tomography abdomen and pelvis with oral contrast demonstrating target-shaped lesion in the right lower quadrant indicative of ileocecal intussusception.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC2908657&req=5

f1-wjem-11-197: Computed Tomography abdomen and pelvis with oral contrast demonstrating target-shaped lesion in the right lower quadrant indicative of ileocecal intussusception.
Mentions: The patient’s workup included a white blood cell count of 6.2 thous/mcL (reference range: 4.0–10.5) and elevated liver enzymes with aspartate aminotransferase (AST) of 66 IU/L (reference range: 8–40) and alanine aminotransferase (ALT) of 115 IU/L (reference range: 0–60). Normal total bilirubin was 0.4mg/dL (reference range: 0–1.4) and normal alkaline phosphatase was 50 IU/L (reference range: 26–110). Prothrombin time (PT) and international normalized ratio (INR) were elevated at 15.2 (reference range: 9.6–11.8) and 1.31 (reference range: 0.89–1.11), respectively. Partial thromboplastin time (PTT) was normal at 28.6 (reference range: 24.2–32.6). Urine analysis was negative for urinary tract infection. Urine pregnancy test was negative. Abdominal and pelvic duplex ultrasounds were unremarkable. Computed tomography (CT) scan of abdomen and pelvis showed a target lesion in right lower quadrant with obstruction of contrast and pericolonic fat stranding indicative of intussusception at the ileocecal junction (Figure 1).

Bottom Line: We also present the case of a 66-year-old male, who presented with one week of intermittent lower abdominal pain associated with several episodes of nausea and vomiting.The etiology may be associated with pathological processes such as carcinoma or iatrogenic causes, such as scars or adhesions from prior surgeries.The cases presented here demonstrate important etiologies of abdominal pain in adult patients.

View Article: PubMed Central - PubMed

Affiliation: University of California, Irvine, Department of Emergency Medicine, Irvine, CA.

ABSTRACT

Background: Intussusception is a condition found primarily in the pediatric population. In the adult population, however, intussusception is usually due to a pathological process, with a higher risk of bowel obstruction, vascular compromise, inflammatory changes, ischemia, and necrosis. Radiographic and sonographic evidence can aid in the diagnosis. Surgical intervention involving resection of affected bowel is the standard of care in adult cases of intussusception.

Case reports: We present the case of a 21-year-old female who presented to the Emergency Department with diffuse cramping abdominal pain and distention. Workup revealed ileocecal intussusception, with a prior appendectomy scar serving as the lead point discovered during exploratory laparotomy. We also present the case of a 66-year-old male, who presented with one week of intermittent lower abdominal pain associated with several episodes of nausea and vomiting. Workup revealed ileocolic intussusception secondary to adenocarcinoma of the right colon, confirmed upon exploratory laparotomy with subsequent right hemicolectomy.

Conclusion: In the adult population, intussusception is usually caused by a lead point, with subsequent telescoping of one part of the bowel into an adjacent segment. While intussusception can occur in any part of the bowel, it usually occurs between a freely moving segment and either a retroperitoneal or an adhesion-fixed segment. The etiology may be associated with pathological processes such as carcinoma or iatrogenic causes, such as scars or adhesions from prior surgeries. The cases presented here demonstrate important etiologies of abdominal pain in adult patients. Along with gynecological etiologies of lower quadrant abdominal pain in female patients, it is important for the emergency physician to expand the differential diagnosis to include other causes, such as intussusceptions, especially given the symptoms that could be associated with bowel obstruction.

No MeSH data available.


Related in: MedlinePlus