Ileocolic Intussusception in an Adult due to Acute Appendicitis

Abstract

Intussusception is a well-recognized clinical entity that has been mainly attributed to pediatric population. Adult intussusception is an extremely rare condition presenting with diverse symptomatology. A high index of suspicion and early diagnosis with a CT scan will identify patients requiring emergent surgery. Present case report describes a patient with presentation of acute appendicitis and ultimately diagnosed to have ileocolic intussusception. Laparoscopic reduction of the intussusceptions and appendectomy cured the condition.

Appendiceal intussusception with appendiceal–caecal fistula in adults caused by acute appendicitis: case report and literature review

“…Although it only accounts for up to 5% of bowel obstructions in adults, 90% of cases are due to underlying intestinal pathology ranging from polyps to neoplasms 1 . Unlike infants, adults exhibit non‐specific symptoms including colicky pain, nausea, bowel changes and gastrointestinal bleeding 3,4 . Surgical resection remains the mainstay treatment in most cases of adult intussusception due to high risk of malignancy 5 .…”

“…Appendiceal intussusception is rare with an incidence of 0.01% in a post‐mortem study over the course of 40 years of 71 000 specimens of the human vermiform appendix of patients suffering from appendicitis 6 . It has been hypothesized that appendiceal intussusception results from irritation within the intestinal lumen that alters peristalsis and leads to invagination of the appendix into an adjacent segment 3 . As both acute appendicitis and appendiceal intussusception are present, the question of ‘cause and effect’ remains to be answered, as the literature on this subject is still scarce 7 .…”

“…1 Unlike infants, adults exhibit non-specific symptoms including colicky pain, nausea, bowel changes and gastrointestinal bleeding. 3,4 Surgical resection remains the mainstay treatment in most cases of adult intussusception due to high risk of malignancy. 5 We present a case of appendiceal intussusception with appendicealcaecal fistula caused by an acute appendicitis treated with laparoscopic-assisted limited ileocolic resection.A 50-year-old female presented with colicky right lower quadrant abdominal pain that she reported began 3 days prior associated with nausea but otherwise denied vomiting or abdominal distension.…”

“…6 It has been hypothesized that appendiceal intussusception results from irritation within the intestinal lumen that alters peristalsis and leads to invagination of the appendix into an adjacent segment. 3 As both acute appendicitis and appendiceal intussusception are present, the question of 'cause and effect' remains to be answered, as the literature on this subject is still scarce. 7 Although ultrasound studies can be highly specific and sensitive in children, CT imaging is superior, with a 78% diagnostic yield amongst adults.…”

Adult Ileocolic Intussusception from the Appendix

“…The majority of adult intussusception patients also report pain as a major symptom, present in upwards of 90% of cases, with pain intermittency or periodicity being of significance due to the potential delay in diagnosis [5]. While only accounting for a small portion of bowel obstructions, the majority of adult intussusceptions are linked to underlying bowel pathologies [6], making it exceedingly important to promptly diagnose, and treat the intussusception, and its underlying causes. The present case describes an incidence of ileocolic intussusception secondary to acute appendicitis treated surgically with favorable outcomes.…”