Abstract
Despite improvements in imaging modalities, causative lead points in adult intussusception may be difficult to diagnose. Such lead points can be malignant, causing recurrence or metastases if left unresected. We describe a case of transient adult jejunojejunal intussusception, in which intraoperative endoscopy was used to confirm the absence of a lead point. A 39-year-old woman with a history of laparoscopic oophorectomy presented with epigastric pain, nausea, and vomiting. Contrast computed tomography revealed jejunojejunal intussusception, with no visible lead point. Spontaneous reduction was confirmed during exploratory laparoscopy. After lysis of adhesions, intraoperative peroral jejunoscopy was performed with the surgeons' assistance. Endoscopy confirmed the absence of tumor, and bowel resection was avoided. No recurrence has been observed during 24 months of follow-up. Intraoperative endoscopy may provide additional reassurance for the absence of a lead point in cases where preoperative enteroscopy cannot be performed and no lead points can be identified on imaging.
Highlights
While intussusceptions in children are commonly idiopathic, adult intussusceptions (AI) generally have a causative lead point
AI presents two problems for the patient: symptoms relating to bowel obstruction and a potentially malignant lead point
AI can be difficult to diagnose due to its rarity and the chronic, nonspecific nature of its symptoms [1, 4]
Summary
While intussusceptions in children are commonly idiopathic, adult intussusceptions (AI) generally have a causative lead point. The most common type accounting for about 50% of AIs, have been reported to result from malignant tumors in 22.5% of cases, with metastatic carcinoma being the most common malignant lead point [1]. On the other hand, avoiding surgery may occasionally come at the cost of missing a malignant small bowel tumor, which may be undetected despite recent advances in imaging modalities [8,9,10,11,12]. Such an event may have various devastating results, including recurrence and metastatic disease. Case Reports in Gastrointestinal Medicine in the jejunum, providing additional reassurance that bowel resection could be avoided
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