An Extremely Rare Coexistence: Acute Appendicitis and Multiple Intussusceptions in an Adult

Abstract

SummaryBackgroundAdult intussusception is a rare phenomenon, acute appendicitis accompanying multiple transient intussusceptions are much more uncommon. Satisfaction and quiting imaging studies after finding an intussusception on ultrasound, may lead diagnostic errors. Radiologists should raise their awareness of imaging findings in intussusception and keep in their mind coexistent troubles in the belly. This unique case presents unusual imaging findings of a rare dual abdominal emergency condition, particularly highlighting the value of abdominal computed tomography.Case Report32-year-old female was admitted to Emergency Department with complaints of epigastric abdominal pain and vomiting. US identified ‘target’ appereance on left paramedian location at umbilical level. Contrast enhanced abdominal CT not only confirmed the enteric intussusception that was demonstrated on previos US, but also showed additional concomitant intussusceptions and inflamed appendix.ConclusionsAdult intussusception is a rare phenomenon, multiple transient intussusceptions are even more uncommon. This unique report adds, precious clinical and imaging findings of acute appendicitis coexisting with multiple spontaneously resolving intussusceptions, to the literature. Physicians should be alerted for accompanying multiple abdominal pathologies and use justification essentials to make their decisions about the selection of the appropriate imaging modality.

Incidental appendectomy in surgical treatment of ileocolic intussusception in children. Is it safe to perform?

“…During the follow-up period of our study, no acute appendicitis has been described in the NA group after surgical reduction of the intussusception, but the follow-up time is still short due to the young age at which the intussusception occurred (15-16 months of age), so longer-term follow-up will be necessary to determine this aspect. Other reasons supporting the performance of appendectomy associated with surgical reduction of the ICI are reported by multiple reports describing an abnormal appendix which serves as a lead point for intussusception (21,22) , as well as numerous cases of ICIs in which an inflamed appendix is thought to be the lead point (23,24) . Appendiceal intussusception has also been described, although it is much more uncommon (25,26) .…”

Intussusception secondary to descending colon lipoma presenting with simultaneous acute appendicitis

“…The history and physical findings, especially periumbilical pain that migrates to the right lower quadrant, helps to establish the diagnosis of acute appendicitis. Acute appendicitis simultaneously accompanying intussusception is extremely rare; only one similar case has been reported [ 7 ]. In the present patient, the symptoms, physical examination and laboratory findings were consistent with acute appendicitis.…”

Apendicectomía incidental en el tratamiento quirúrgico de la intususcepción ileocólica en niños. ¿Es segura?

“…Aun así, el tiempo de seguimiento sigue siendo escaso debido a la corta edad a la que se produjo la intususcepción (15-16 meses), por lo que hará falta prolongarlo para determinar este aspecto. Muchos artículos esgrimen motivos a favor de la realización de una apendicectomía asociada a la reducción quirúrgica de la IIC, como la existencia de un apéndice anómalo que puede servir como punto guía para la intususcepción (21,22) , o numerosos casos de IIC en los que se cree que el punto guía puede ser un apéndice inflamado (23,24) . También se ha descrito la intususcepción apendicular, aunque es mucho menos frecuente (25,26) .…”