Transient Intussusception

Abstract

Intussusception is the invagination of a bowel segment into the contiguous intestinal tract. It can be further classified according to their location as enteroenteric, colocolonic and enterocolonic, being ileocecal the most common. On CT images, we can recognize three different patterns like target, reniform and sausage shaped. This is a 33-year-old man with a PMH of heroin abuse. Patient was brought to the ER complaining of a right lower abdominal pain. This pain started 2 hours prior arrival to ER and it was described as sharp, stabbing, and radiating to the entire abdomen with associated nausea and vomiting. He denied Any fever. Vital signs showed a BP of 139/80 mmHg, pulse of 80 bpm, RR of 20 and temperature of 99.4 F. On physical exam, the abdomen was soft with tenderness to palpation of RLQ but without rebound. A CT abdomen was done diagnosing short segment of jejunal-jejunal intussusception in the left mid abdomen. Fifteen hours later a repeated CT showed a resolved intussusception, after which the patient underwent a diagnostic laparoscopy where a normal appearing jejunum and ileum without was seen, without any evidence of intussusception. There were no bleeding points or tumors noted on the external surface of both the jejunum and ileum and the appendix appeared grossly normal. Procedure was terminated and the patient was discharged, without any further workup. It is interesting to mention that the mechanism of any intussusception seems to be related to a bowel lesion that serves as a lead point. Although rare, cases of transient episodes have been seen in patients with celiac or Crohn's disease. Unfortunately, our patient was discharge without any further evaluation of the etiology of this episode. Moreover, other diagnostic methods like intraoperative enteroscopy, push-enteroscopy or MR enterography could have been appropriate in this case to find any intraluminal tumors and/or inflammatory process. We report this case to encourage physicians to perform a deeper assessment of the etiology of an episode of intussusception, regardless of its transient nature, since patients can have reoccurring events in the future.Figure: CT abdomen at admission showing intussusception.Figure: CT abdomen- coronal view at admision: intussusception measuring about 5.5 cm in length in the left abdomen.Figure: CT abdomen 15 hours after: where previously seen intussusception has resolved.