Abstract
Intussusception of the gastrointestinal viscera is rarely encountered in adult patients and is frequently associated with a polypoidal lead point, which is often malignant. We would like to present the case of a 68-year-old male with a history of decompensated liver disease and multiple medical comorbidities, who was discovered to have an incidental gastrogastric intussusception on CT. No polypoidal lead point was seen and we believe this to be the first case of its kind to be described. We suggest that distortions in the patient’s visceral and vascular anatomy and raised intra-abdominal pressure resulting from concomitant ascites, hiatus hernia, portal hypertension and oesophageal varices have provided an alternative mechanism for a gastrogastric intussusception to develop.
Highlights
The earliest known description of intussusception was made by the Dutch physician Paul Barbette in 1674, with successful manual reduction of an intussusception being first performed by Sir Jonathan Hutchinson in 1871 in a 2-year-old girl following failure of hydrostatic reduction.[1]
This study has suggested that portal hypertension resulting in vascular congestion due to dilated and thickened capillaries may have functioned as a lead point for the development of colonic intussusception, and noted that this mural thickening became worsened as liver cirrhosis progressed
Whilst it is not known whether our patient exhibited any weaknesses in the fixation of his gastric ligaments, we would suggest that the presence of a hiatus hernia could still predispose individuals to gastrogastric intussusception via a similar mechanism, without simultaneous involvement of the oesophagus
Summary
The earliest known description of intussusception was made by the Dutch physician Paul Barbette in 1674, with successful manual reduction of an intussusception being first performed by Sir Jonathan Hutchinson in 1871 in a 2-year-old girl following failure of hydrostatic reduction.[1]. Fluoroscopic studies of patients presenting with this condition have revealed a “coiled spring” appearance, whilst CT and MR studies have demonstrated the appearance of a “target sign”. Both radiological features are frequently reported in cases of distal intussusception involving the intestines and it is logical that they would be seen in cases of gastrogastric intussusception as the mechanism of anatomical distortion which results in telescoping of all layers of the wall of the viscus is conserved. It is noteworthy that all but one of the patients who have been included in the above case
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