Abstract
Intussusception is a rare condition in adulthood and, unlike in children, is usually caused by an identifiable underlying lesion, most commonly a gastrointestinal tumour. The clinical presentation is non-specific and often there are intermittent symptoms making the diagnosis difficult based solely on history and examination. Plain radiography may reveal signs of bowel obstruction, however, CT is the gold standard to diagnose and localise an intussusception in adults. We present an unusual case of adult ileocolic intussusception caused by an ileal leiomyoma. This case highlights the important radiological findings of intussusception presenting with a high-grade obstruction and discusses the potential causes which should be considered.
Highlights
A 50-year-old female with no significant past medical history presented to the emergency department of a tertiary hospital with a 5-day history of intermittent lower abdominal pain which had worsened in the preceding few hours
There was a typical appearance of terminal ileum telescoping into the caecum at the point of the lesion and distally the colon was completely collapsed (Figure 2), consistent with an ileocolic intussusception with the calcified mass as the lead point
Adults tend to present with intermittent or vague abdominal pain over a period of time without any distinct clinical signs on examination to differentiate it from other causes of obstruction.[1]
Summary
The pain was associated with nausea, vomiting and anorexia She had been constipated for 4 days which was atypical for the patient. Liver function tests and other electrolytes were unremarkable. She was hemodynamically stable and proceeded to have a contrast-enhanced CT of the abdomen and pelvis with contrast. Investigations Abdominal CT with intravenous contrast showed marked fluid distension of the stomach and small bowel, in keeping with a high-grade obstruction, which extended to a 12 mm calcified lesion in the terminal ileum (Figure 1). There was a typical appearance of terminal ileum telescoping into the caecum at the point of the lesion and distally the colon was completely collapsed (Figure 2), consistent with an ileocolic intussusception with the calcified mass as the lead point. Spindle cells focally involved the outer aspects and these stained with actin and desmin, confirming the lesion to be a submucosal leiomyoma
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