Do All Adult Patients with Small Bowel Intussusception Need Surgery?

Abstract

Introduction: Intussusception of the small bowel accounts for less than 1% of cases of small bowel obstruction in adults. It has traditionally been regarded as a condition requiring surgery, because up to 90% of cases are said to be associated with a lead point disease. We present a case of small bowel intussusception in an adult, which was transient and managed conservatively without surgical intervention. Case: A 23-year-old man presented to the Emergency Department with a three-day history of right-sided abdominal pain, nausea and bilious vomiting. On arrival, his temperature was 97.7° F and his pulse rate was 79 beats per minute. Examination revealed a non-distended abdomen with right lower quadrant tenderness without guarding or rebound tenderness. His white cell count was 13,000 per cmm and hematocrit was 50 percent. Plain-film radiograph of the abdomen revealed a non-obstructive bowel gas pattern. Computed tomographic scanning of the abdomen showed a “target lesion”, suggestive of small bowel intussusception (Figure 1). However, no abnormality was demonstrated on barium small bowel follow-through performed the next day. The patient's general condition improved with bowel rest. Discussion: The reported frequency of lead point disease with adult small bowel intussusception is based on surgical series in which patients had obstructive symptoms and the diagnosis was made intraoperatively. However recent series using CT or MRI diagnosis of intussusception found increased rate of idiopathic transient intussusception approaching 50%, especially in small bowel. Features suggestive of transient intussusception are incidental presentation, proximal small bowel location, absence of peristaltic obstruction, absence of any apparent cause, target like lesion on CT scan and intussusception length less than 3.5 centimeter. Many cases of adult small bowel intussusception that are detected with computerized tomography are self-limiting. This highlights the need for considering conservative approach in management of small bowel intussusception in adults.[figure 1]Figure