Adult intussusception with CT and intra-operative illustration

Abstract Adult intussusception is rare. Diagnosis can be challenging and the effective management remains controversial. Many surgeons may never have seen a single case of intussusception, and it may not be considered in the differential diagnosis of recurrent intermittent abdominal pain or acute intestinal obstruction. We present a case report of a forty three year old athletic woman who presented with a ten days history of recurrent generalised abdominal pain and obstructive symptoms. CT performed aided diagnosis by demonstrating, the stomach to be fluid filled and distended, small bowel dilated to the level of the mid ileum, large bowel collapsed, collapsed loops of ileum seen with evidence of omental fat and blood vessels within the lumen of the ileum. We present the classical CT appearance of intussusception, ‘doughnut’ sign (bowel within bowel image), alongside intra-operative visual images highlighting this rare and extensive segment of ileum intussuscepting to the distil transverse colon. A right hemicolectomy was performed, with the remainder of the laparotomy being normal. Histology showed a large polypoid tubulovillous adenoma with mild to moderate (low-grade) dysplasia sitting at the advancing tip of the intussuscepted fragments, and hence acting as the lead point. Post-operative our patient has done well and at four weeks outpatient clinic there was no issues of concern.