Case Report: Rare presentation of adult intussusception at Orotta National Referral Hospital, Eritrea

Abstract

A 38-year-old woman presented at Orotta National Referral Hospital emergency department in May 2017 with pain in the epigastric region and vomiting. Physical examination revealed no pertinent findings. Blood and urine tests were normal, and erect abdominal x-ray revealed a distended small intestine with multiple layers of “air-fluid levels”. CT scan and MRI were not done due to their temporary unavailability. During laparotomy a large mass of 20x20 cm in size was detected in the mid-jejunum of the small intestine. This leading tumor caused intussusception and coiling of the small intestine. As there are no typical symptoms of intussusception, it is very important to do CT scan for patients with long-standing abdominal pain and vomiting to achieve a definitive diagnosis of intussusception.

Rare Idiopathic Adult Intussusception: A Case Report

“…Of these, the vast majority (90%) of cases can be attributed to an identifiable neoplasm, and the remainder (10%) are idiopathic [6,9]. While the exact mechanism is still unknown, it is believed that a pathological lead point or lesion within the bowel wall alters normal peristaltic activity [11], leading to the invagination of a proximal segment of the bowel into a distal segment, resulting in obstruction [1][2][3][4][5][6]. Other predisposing factors for small bowel intussusception in adults include anorexia nervosa and malabsorption syndromes due to the increased flaccidity of the bowel wall, which facilitates invagination, and supratherapeutic anticoagulation therapy, which may cause submucosal hemorrhages that can lead to intussusception [6].…”

“…Intussusception is classically defined as the telescoping of a proximal segment of the bowel into a distal segment [1][2][3][4][5][6]. It is the most common cause of intestinal obstruction in children under three years of age [7,8].…”

Totally laparoscopic treatment of intestinal tuberculosis complicated with bowel perforation: The first case report in worldwide literature with a brief review

“…Even though several internal organs can be involved, the most common sites include the peritoneum, bowel, especially the ileocecal area and/or lymph nodes ( 15 ). Among clinical manifestations that can occur in intestinal TB, including abdominal pain, diarrhea, lower gastrointestinal bleeding, constipation, and constitutional symptoms (fever, malaise, night sweats, anorexia, and weight loss), several complications figure an acute abdomen that could require surgical intervention, such as fistula, intestinal strictures ( 16 ), bowel obstruction, intussusception ( 17 ), and perforation ( 18 , 19 ). Bowel perforation is an uncommon complication of intestinal TB that may occur more commonly in hypertrophic variety due to the reactive thickening of the peritoneum and subsequent adhesion formations that may subsequently perforate ( 20 ).…”