3219 Intussusception Not Just a Pediatric Problem

Abstract

INTRODUCTION: Intussusception is usually considered a pediatric condition, but it may also be present in adults, where it is more often associated with an underlying pathology. In adults, intussusception is found in only 1% of patients with bowel obstructions. Most cases have distinct lead points, this in comparison to the pediatric cases is contrasting where more 90% of the cases are idiopathic. Malignancy is the most common cause of pathologic lead point. CASE DESCRIPTION/METHODS: 20 year old male with known history of Crohn's previously on Vedolizomab, presents with nausea, vomiting with melena. He was initially rehydrated intravenously along with IV steroids. On presentation his vitals indicated that he was slightly hypotensive and tachycardiac. Abdominal exam demonstrated a diffusely tender abdomen with no signs of guarding or rigidity. CT Abdomen revealed mucosal enhancement and wall thickening of the terminal ileum and cecum indicating Crohn's flare up along with Jejunu-jejunal intussusception in the left upper quadrant persistent on both arterial and delayed phases. Surgery was consulted however no surgical intervention was planned as no tumor, obstruction or lead point was identified. A small bowel follow through with gastrografin was planned which revealed resolution of the intussusception. The patient subsequently got better with appropriate management of his Crohn's flare. He was discharged with recommendations to follow up with his Gastroenterologist for Vedolizomab infusions. DISCUSSION: Adult onset intussusception presents with recurrent abdominal pain and due to the rarity of the condition the diagnosis is often missed or delayed. Abdominal CT is the most useful test in diagnosing intussusception. While most cases of adult onset intussusception require a surgical approach it is important for clinicians to be aware that it is not true for all cases. Transient intussusception has been observed occasionally on small bowel barium studies in patients with Crohn's and adult celiac disease. If no lead point is identified or in cases of transient small-bowel intussusceptions in the setting of celiac sprue or Crohn's disease surgery is not needed. Non surgical reduction in cases when no necrosis is identified has several advantages including avoidance of surgery, limiting the extent of bowel resection and decrease the risk of complications such as short gut syndrome. When dealing with adult onset intussusception it is important to consider the aforementioned factors.