S2970 Multiple Jejunal Intussusceptions in a Patient With Portal Hypertension and Decompensated Liver Cirrhosis

Abstract

Introduction: Intussusception is telescoping a part of the intestine into itself. Common complaints including abdominal pain, nausea, vomiting, bleeding, melena and constipation. Treatment largely depends on patients' clinical status, age, and the part of the intestine involved. Treatment approaches include fluoroscopic, sonographic, surgery or observation. 90% of adult intussusception occurs due to lead points. We present a case of intussusception in a patient with decompensated liver cirrhosis and portal hypertension (PH). Given no identifiable lead point, we postulate that the patient’s medical conditions contributed to development of idiopathic intussusception. Case Description/Methods: A 48yo undomiciled female with unknown past medical history was brought to the Emergency Department for alcohol intoxication. In the ED she complained of abdominal pain but was unable to further qualify specific features of her symptoms. She was nauseous and had several episodes of non-bilious, non-bloody vomiting. Upon further questioning, she endorsed drinking 5 beers/day. Vital signs were notable for blood pressure of 90s/60s mmHg. She had significant scleral icterus and a distended abdomen with dullness. Initial labs are as shown in table 1. CT revealed cirrhotic liver, evidence of PH, three intussusceptions in the jejunum without associated obstruction (Figure 1). She was treated for severe hyponatremia due to beer potomania. In view of her anemia, she was transfused packed RBCs and EGD was performed. It revealed non-bleeding large esophageal varices which was banded. Mild PH gastropathy was also found in the entire stomach. She was treated supportively; the hyponatremia was corrected and her abdominal pain improved. Repeat CT scan one week later revealed resolution of jejunal intussusception. Discussion: Adult intussusception is uncommon in comparison to the pediatric population. A clear lead point can be identified 90% of cases with two thirds being due to neoplasms and 60% of neoplasms being malignant. PH can cause vascular changes in the intestine including colorectal varices, angiodysplasia-like lesions, telangiectasias, dilated and congested capillaries. It is unclear if those vascular changes in PH and cirrhosis cause lead points for intussusception. There are some case series demonstrating intussusception in cirrhotic patients but there is no comment on the relationship between PH and intussusception1. Further studies can be done to show the relation between PH/cirrhosis and intestinal intussusception.Table 1.: Initial Significant Lab Values.Figure 1.: Jejunal intussusceptions on CT of Abdomen and Pelvis.