Idiopathic double telescoping intussusception in an adult

Abstract

Intussusception is uncommon in adults compared with the pediatric population. Unlike its pediatric counterpart, intussusception in adults is associated with obvious pathology. Small bowel intussusceptions are much less common than the ileocolic type, with jejunoileal intussusceptions being amongst the rarest. There are no reports of double intussusception in literature. We report a first case of double telescoping intussusception in an adult where the proximal ileum (intussusceptum) is telescoping into distal ileum (intussuscipiens) and this as a whole is again telescoping into terminal ileum. A 46-year-old woman came to the emergency ward with a three-day history of pain abdomen, distension and multiple episodes of bilious vomiting. The abdomen was distended and there was rebound tenderness on palpation. There was a palpable mass just below the umbilicus. Plain X-ray abdomen showed multiple air fluid levels. Ultrasonography of abdomen showed dilated bowel loops, with target sign giving an impression of ileoileal intussusception. Intraoperatively double telescoping ileoileal intussusception was present one foot proximal to ileocecal junction. Resection of the ileal segment bearing the intussusception with end ileostomy was done. Intussusception in adults is very rare and has an identifiable cause in 80% of cases. Double telescoping intussusception is the condition where there will be a proximal segment intussuscepting in to the distal segment and this whole thing will again intussuscept into the still farther segment of intestine.