Small Bowel Intussusception Research Articles

Pyridostigmine as treatment for chronic gastrointestinal dysmotility in a child with Mowat‐Wilson syndrome: A case report and literature review

Abstract Gastrointestinal dysmotility is commonly reported among patients with Mowat‐Wilson syndrome (MWS) and poses a significant symptomatic burden. Unfortunately, there remains a knowledge gap regarding effective treatment strategies. A 2‐year‐old male with MWS presented with chronic paradoxical abdominal pain, constipation, and progressively restricted oral intake. He was diagnosed with intestinal pseudo‐obstruction, due to recurrent transient small bowel intussusception identified on ultrasound. Pyridostigmine, an acetylcholinesterase inhibitor, was successfully used to promote gastrointestinal motility, improving the child's pain symptoms and allowing return to his baseline activities. This case adds to emerging evidence of low‐dose pyridostigmine as a viable treatment to consider for children with symptoms related to impaired gastrointestinal motility, by demonstrating its successful use in a child with MWS for the first time.

Avoiding unnecessary bowel resection in adult intussusception: a case report in a patient with multiple prior surgeries utilizing intraoperative enteroscopy.

Intussusception is a rare condition in adults, accounting for approximately 5% of all cases. Unlike pediatric intussusception, which is typically idiopathic, the adult cases are usually associated with an underlying pathology, most commonly malignancies. The surgical intervention is often required, but in small bowel cases, where malignancy is less frequent than in colonic intussusception, the decision regarding resection requires careful consideration. There are no prior reports on the use of intraoperative enteroscopy for small bowel intussusception evaluation. We report the case of a 78-year-old woman who presented with acute abdominal pain, nausea, and bilious vomiting. She had a history of distal gastrectomy with gastroduodenostomy (Billroth-I) and total gastrectomy with Roux-en-Y for gastric ulcer and residual stomach cancer, respectively. Abdominal computed tomography (CT) revealed small bowel intussusception without clear evidence of a lead point lesion. The emergency laparotomy confirmed intussusception 15cm distal to the Roux-en-Y anastomosis, which was manually reduced. The intraoperative enteroscopy revealed inflammatory changes but no malignancy or structural abnormalities. Given the absence of a lead point lesion and the viability of the bowel, resection was avoided. The patient had an uneventful postoperative course and was discharged without complications. Adult intussusception is frequently associated with malignancy, yet cases without a lead point lesion pose a diagnostic and therapeutic challenge. The surgical history, including prior anastomotic procedures, may contribute to the pathogenesis through disrupted intestinal pacemaker activity and retrograde contractions. While second-look surgery can aid in bowel viability assessment, it carries a high complication rate. This case highlights the potential role of intraoperative enteroscopy in evaluating small bowel viability, minimizing unnecessary resection, and improving surgical decision-making. Although further studies are needed to assess its role in optimizing surgical outcomes, intraoperative enteroscopy may be a valuable adjunct in cases of adult small bowel intussusception without an apparent lead point.

Transient and persistent small-bowel intussusception in children: a decision tree analysis model based on ultrasound and clinical findings

PurposeTo develop a systematic and efficient decision tree analysis (DTA) model to improve the diagnostic accuracy of transient small-bowel intussusception (TSBI) and persistent small-bowel intussusception (PSBI) in children.MethodsFrom February 2019 to June 2022, ultrasound (US) features and clinical findings of pediatric patients with small-bowel intussusception (SBI)—including SBI diameter, outer bowel wall thickness, thickness of the head and body of the intussusceptum, length of the intussusceptum, and presence of pathological lead points (PLPs)—were recorded and analyzed. A classification and regression tree algorithm was then used to develop a DTA model, which was trained and validated by randomly categorizing the patients into training (60%, 200/331) and validation (40%, 131/331) datasets to assess diagnostic performance.ResultsA total of 331 patients with SBI (270 with TSBI and 61 with PSBI) were included; the maximum age was 9 years. The initial diagnostic predictor in the DTA model was the detection of a PLP via US, followed by intussusceptum length (P < 0.001). The sensitivity, specificity, and accuracy of the DTA model were 98.2%, 100%, and 98.6%, respectively.ConclusionThe DTA model developed in this study facilitated the differential diagnosis of TSBI and PSBI in pediatric patients with SBI, with a clinical concordance rate of 98.6%.

Rare invasive inflammatory fibroid polyp presenting as small bowel intussusception: Two case reports and review of the literature.

Inflammatory fibroid polyp (IFP) is a rare benign neoplasm of uncertain etiology and mostly occurs in the stomach, emerging from the submucosal layers. Intussusception causing bowel obstruction due to IFP is even rare. We present 2 cases of IFP in adults, which caused small bowel intussusception and broke through the submucosa uncommonly. This article reports 2 patients presenting with abdominal pain. One patient was an 81-year-old Chinese man, who presented with a 7-day history of intermittent left abdominal pain. The other patient was a 49-year-old Chinese woman with a 5-day history of intermittent lower abdominal distension pain. Their abdominal computed tomography both demonstrated small bowel intussusception. The 2 patients were diagnosed with small bowel intussusception. Both patients underwent surgical resection of a segment of the small intestine. During the old man's operation, a 2.5 cm × 3.5 cm polypoid tumor was found in the jejunum, at a distance of 60 cm from the ligament of Treitz. During the women's operation, a 3.6 × 3.7 cm polypoid lesion was found in the ileum, which protruded into, and completely occluded the lumen. The 2 patients had an uneventful recovery, being discharged about 1 week postoperatively without any postoperative complications. Morphologically, the old man's intraluminal intestinal mass had invaded muscularis propria, and was negative for CD34 immunohistochemically, creating difficulties in diagnosing IFP. The woman's intraluminal intestinal mass had infiltrated into the serosal layer. Ultimately, the pathological diagnosis for both patients was IFP. We described 2 rare cases of small bowel intussusception caused by IFP. IFP commonly involves only the submucosa, rarely breaks through the submucosa, and invades the muscularis propria and subserosa layer. Its invasive nature is extremely rare and may provide additional evidence to support the neoplastic nature of IFP. Besides, a differential diagnosis is essential When an IFP is negative for CD34 expression.

Balloon-assisted enteroscopy in the management of adult small-bowel intussusception: a comparative analysis of with and without double-balloon enteroscopy.

Adult small-bowel intussusception (ASI) is a rare condition with pathological etiologies in most patients. Previously, surgical intervention was the primary treatment modality; however, the introduction of balloon-assisted enteroscopy (BAE) has allowed preoperative BAE in some cases to confirm the leading point, thereby guiding management and reducing surgical need. In this study, we investigated whether the introduction of BAE has altered the diagnostic and therapeutic strategies for ASI by retrospectively analyzing and comparing the clinicopathological features of patients before and after its introduction. Fifty-three patients with ASI, initially diagnosed via abdominal computed tomography scanning at Korea University Guro Hospital from 2000 to 2023, were included in our study. Patients were grouped based on double-balloon enteroscopy (DBE) usage, and clinicopathological outcomes were compared retrospectively. Of the 53 patients, 38 (71.7%) had enteroenteric-type intussusception and 15 (28.3%) had enterocolic-type intussusception. Among the patients with enteroenteric-type intussusception, 15.8% had a malignant cause, whereas in the enterocolic type, 60% had a malignant cause (p = 0.001). Of 38 patients with enteroenteric ASI, 15 (39.5%) underwent preoperative DBE. The surgical resection rate was significantly lower in the DBE group (40%) than in the non-DBE group (73.9%) (p = 0.037). Pathological diagnoses of patients who underwent surgical resection without preoperative DBE revealed 17.6% malignancies and 82.4% benign causes, including idiopathic intussusception (four cases) and Peutz-Jeghers syndrome (two cases). No morbidity, mortality, or recurrence was observed. Preoperative BAE is a valuable diagnostic and therapeutic modality for ASI, particularly in cases of low-grade small-bowel obstruction, reducing surgical resection rates in most ASI cases. The introduction of the BAE has significantly improved ASI management, achieving high successful reduction rates and few surgical interventions. BAE should be considered a first-line diagnostic and therapeutic tool for ASI management.

An Unusual Case of Adult Intussusception - A Case Report

Introduction: In Adults intussusception as a cause of small intestinal obstruction is a rare condition. Among the lead points for intussusception intestinal polyps are most common and also there are probabilities of malignant tumors which usually become greater from proximal to distal colon. Fibroid polyps are most uncommon benign pathology leading to intussusception of small bowel, presented in our case report. Case presentation: A 45 years old lady admitted in surgery ward of Sylhet Women’s Medical College Hospitalwith the features of small bowel obstruction for 5days. The abdominal ultrasonography report was suggestive of bowel mass resulting small bowel obstruction. Than multi axial contrast computed tomography of whole abdomen was done, which showed jejunoileal intussusception with intestinal obstruction. An intussusception with an intraluminal solid tumour at its lead point approximately 240cm distal to dudenojejunal flexure was found on exploratory laparotomy. Resection and anastomosisof affected bowel segment was done. Histopathological examination showed inflammatory fibroid polyp, ulcerated. Conclusion: In case of small bowel obstruction due to intussusception with a lead point of inflammatory fibroid polyp surgical approach is the most preferable solution though it is a benign condition.

Adult Intussusception in Jordan: Demographics, Clinical Features, and Outcomes from a Tertiary Hospital.

BACKGROUND Adult intussusception (AI) is a rare condition with diverse clinical presentations and management challenges. Despite its rarity, understanding its epidemiology, clinical features, and predictive factors distinguishing benign and malignant lead points is crucial for effective management. This study aimed to assess the demographic and clinical characteristics of patients with pathological AI and examine factors associated with malignant lead points. MATERIAL AND METHODS Medical records of patients aged >18 years with diagnosis of AI between January 1, 2014, and January 1, 2024 were retrospectively analyzed. Patients were classified based on location and etiology of intussusception. Predictive factors for malignant lead points were assessed, including age, sex, presenting symptoms, location, and size of intussusception. Computed tomography (CT) scan images were reviewed for diagnosis confirmation. Transient small bowel intussusceptions and intussusceptions related to feeding tubes were excluded. RESULTS Twenty-six cases of pathological AI were identified over 10 years, with a male predominance (69.2%) and a mean age of 53.3 years. Abdominal pain was the most common presenting symptom (65.4%), with bowel obstruction diagnosed in 23.1% of cases. CT scans were the primary diagnostic modality (92.3%). Colocolic intussusceptions were most prevalent (53.8%), and surgical management was common (69.2%). Histopathological examination revealed benign lead points in the majority (57.7%) of cases, with lipomas and polyps being the most common. Bleeding per rectum was significantly associated with malignant lead points (P=0.011). CONCLUSIONS AI presents with diverse clinical features. It predominantly affects the colon. Bleeding per rectum indicates a higher likelihood of malignant lead points. A multidisciplinary approach is essential for optimal case-based management.

BS SO18 - Small bowel intussusception after Roux-en-Y gastric bypass: A case report and review of literature

Abstract Background Small bowel obstruction after RYGB for obesity can occur due to various common causes like internal hernia and adhesions. One of the rare complications of RYGB is retrograde intussusception of jejunum at the common channel. Since it does not present with typical symptoms of small bowel obstruction, it is often challenging to consider it as differential diagnosis at initial presentation. Also, managing the intussusception at non bariatric centres could prove difficult due to location of it in the common channel, which will require understanding of orientation of alimentary and biliary limbs as well as reconstruction after resection of the intussusception. Method We collected the details of our patients admission episode from a different centre where she was admitted initially to understand the clinical behaviour of the condition. Also, we conducted a systematic search of literature databases like PubMed, Embase, CINAHL, ProQuest Dissertations &amp; Theses using MeSH terms and keywords Intussusception, Retrograde intussusception, J-J intussusception, Intestinal Obstruction, Small bowel obstruction, Bowel obstruction, Obesity, Morbid obesity, Gastric Bypass, Roux-en-Y gastric bypass, Jejunojejunostomy, Jejuno-jejunostomy, Gastric by-pass, RYGB, Roux-en-Y. Data were extracted on to Excel sheet for analysis. Results The search yielded 41 case reports. Patients were operated in most instances except in seven cases where they had multiple episodes. The average age of presentation was 38 mostly in females and few instances being during pregnancy including our patient. Intussusception happened between 5 to 360 months after the initial operation with the average time after the operation being 66 months. Pain was the principal mode of presentation without classical symptoms of bowel obstruction. There were few instances of coffee ground vomiting. CT was the diagnostic modality in almost all cases. Recurrence was invariable when not managed with resection. Conclusion Small bowel intussusception after RYGB occurs retrogradely and does not present with classical symptoms and signs of small bowel obstruction. It can be reliably diagnosed with CT abdomen. Of note, medical management and no-resectional surgical management results in recurrence of this condition.

EGS SO18 - Entero-enteric intussusception secondary to a capillary haemangioma of the small bowel: A case of a diagnostic conundrum

Abstract Background This is a case of a 50 year-old female who presented with acute on chronic abdominal pain, and she was intra-operatively diagnosed with entero-enteric intussusception secondary to a large small bowel tumour . The video demonstrates the findings during the diagnostic laparoscopy. The lead point appeared to be a tumour and histopathology confirmed it is a benign capillary haemangioma. The patient had a long standing history of abdominal pain that was previously investigated on multiple occasions, but without a definitive diagnosis. Method This is an interesting case of a challenging diagnosis of a rare disease. The patient has been suffering for four years with unexplained upper abdominal pain not associated with weight loss, rectal bleed, or change in bowel habit, but had occasional anaemia. The patient had a normal abdominal US, multiple CTs where she was found to have a right renal stone and an OGD that showed gastritis and positive CLO test initially. A repeat OGD and colonoscopy were negative. While the patient was awaiting further investigations for profound iron deficiency anaemia she presented with acute abdomen and required emergency surgery. Results The patient presented to ED with excruciating colicky pain for one day, one episode of melena and nausea. She was haemodynamically stable, peritonitic with increased inflammatory markers, hb 86 g/dL and lactate of 2 mmol/L. The CT abdomen and pelvis showed small bowel intussusception with possible ischemia, therefore the patient underwent an emergency operation.The laparoscopy showed small bowel intussusception and the patient underwent mini laparotomy. The intussusception was reduced, the small bowel was viable and the lead point was a large size tumour.The patient underwent small bowel resection and primary anastomosis, and made good post operative recovery. Conclusion Rare conditions are hard to diagnose. Small bowel intussusception is rare and in adults is usually linked to serious underlying pathology. Capillary haemangioma of the small bowel is very rare too. The patient's symptoms and occassional anaemia can now be explained. Although the patient went through an appropriate work up at the time, her symptoms remained unexplained to some extent or they were linked to other potential causes. Only when the anaemia became profound the patient warranted further investigations. In retrospect, capsule endoscopy would have been inevitable, however the patient became acutely unwell and required an emergency surgery.

065. Ileoileal Small Bowel Intussusception in Adult

Background: Intestinal Intussusception is invagination of a proximal segment of the gastrointestinal tract into the distal. In adults, ileoileal intussusception is a rare case and diagnostically challenging. We present four cases of ileoileal small bowel intussusception in adults. Case: a 19-year-old man with complaint of abdominal pain. An exploratory laparotomy was performed, an ileoileal invagination was found. Second case : a 29-year-old woman with complaint of not being able to defecate or flatus. An ileal dilatation up to 240 cm from the ligament of treitz and ileoileal invagination with an ileal tumor was found in exploratory laparotomy. Third case : a 51-year-old man with complaint of difficulty defecating since 1 day before admission. A 30 cm long ileoileal invagination and tumor in the invaginated ileum was found. Fourth case : a 77-year-old man with a difficulty in defecating. A dilatation of the bowel starting from jejunum-ileum and a 20 cm long invagination was found. Conclusion: Clinical presentation of bowel obstruction is helpful to diagnose adult ileoileal small bowel intussusception. The mainstay of treatment is surgical intervention.

Impact of a 6–12-h delay between ileocolic intussusception diagnostic US and fluoroscopic reduction on patients’ outcomes

BackgroundImage-guided reduction of intussusception is considered a radiologic urgency requiring 24-h radiologist and technologist availability.ObjectiveTo assess whether a delay of 6–12 h between US diagnosis and fluoroscopic reduction of ileocolic intussusception affects the success frequency of fluoroscopic reduction.Materials and methodsRetrospective review of 0–5-year-olds undergoing fluoroscopic reduction for ileocolic intussusception from 2013 to 2023. Exclusions were small bowel intussusception, self-reduced intussusception, first fluoroscopic reduction attempt>12 h after US, prior bowel surgery, inpatient status, and patient transferred for recurrent intussusception. Data collected included demographics, symptoms, air/contrast enema selection, radiation dose, reduction failure, 48-h recurrence, surgery, length of stay, and complications. Comparisons between<6-h and 6–12-h delays after ultrasound diagnosis were made using chi-square, Fisher’s exact test, and Mann–Whitney U tests (P< 0.05 considered significant).ResultsOf 438 included patients, 387 (88.4%) were reduced in <6 h (median age 1.4 years) and 51 (11.7%) were reduced between 6 and 12 h (median age 2.05 years), with median reduction times of 1:42 and 7:07 h, respectively. There were no significant differences between the groups for reduction success (<6 h 87.3% vs. 6–12 h 94.1%; P-value = 0.16), need for surgery (<6 h 11.1% vs. 6–12 h 3.9%; P-value=0.112), recurrence of intussusception within 48 h after reduction (<6 h 9.3% vs. 6–12 h 15.7%; P-value=0.154), or length of hospitalization (<6 h 21:07 h vs. 6–12 h 20:03 h; P-value=0.662).ConclusionA delay of 6–12 h between diagnosis and fluoroscopic reduction of ileocolic intussusception is not associated with reduced fluoroscopic reduction success, need for surgical intervention after attempted reduction, recurrence of intussusception following successful reduction, or hospitalization duration after reduction.Graphical

Polyp Endotherapy for Multiple Jejunal Lipomas Presenting as Small Bowel Intussusception: “Loop and Let Go Technique”

Abstract A 46-year-old woman presented with abdominal pain, vomiting, and intermittent constipation for the last 2 days. She had similar history of recurrent symptoms for the last 6 months. Abdominal examination showed mild central abdominal tenderness and generalized abdominal fullness and no palpable mass. A diagnosis of intestinal obstruction was considered. Nasogastric aspiration was performed with intravenous (IV) antibiotics and IV fluids. Computed tomography (CT) scan of the abdomen showed “bowel in bowel” or “target” sign appearance of jejunum with a submucosal hypodense lesion (suggestive of lipoma) acting as the lead point. There were two more submucosal lipomas of sizes approximately 3 cm each in the distal jejunal loops. A diagnosis of jejunal lipomas causing small bowel intussusception was made. The patient improved with conservative management. Exploratory laparotomy was planned with an intent to resect the small bowel. The patient did not provide consent for the same and so the option of enteroscopy-guided polyp endotherapy was offered to the patient. An antegrade single balloon enteroscopy was done (SIF-Q180, Olympus Medical Systems, United States). Three submucosal lesions with smooth overlying mucosa were noted in the mid and distal jejunum consistent with lipomas. The base of the lesions was ligated tightly using endoloop to make them ischemic and detach. Notable changes in color and mucosal appearance were noted after the application of endoloop. Since all the lipomas detected on cross-sectional radiologic imaging have been tackled via antegrade route, a retrograde enteroscopy was not attempted further. After 2 days, the patient was discharged in stable condition. Follow-up cross-sectional imaging at 3 months showed no residual lipomas, and she remained symptom-free at the end of 6 months.

A rare case of Rapunzel syndrome with small bowel intussusception and bowel obstruction

Rapunzel syndrome is a rare disease that is characterized by a gastric trichobezoar with a long tail extending from the stomach to the small bowel. Patients can be asymptomatic for a long period, and symptoms develop later when the bezoar enlarges in size.

A case of Peutz-Jeghers syndrome presenting as multiple intussusception of small bowel – A rare surgical emergency

Peutz-Jeghers syndrome (PJS) is an autosomal dominant genetic disorder characterised by melanin pigment spots on the oral mucosa, lips, nasal alae, palm and soles, as well as hamartomatous polyps in the alimentary canal. Polyps are often a cause of intussusception in the affected patients. Cancers of the gastrointestinal system, uterus, and breast are common in patients with PJS. Long-term follow-up is required to prevent intussusception in children and cancer in adults. We report a classical case of PJS presenting with multiple intussusception of the small bowel in a 20-year-old male patient.

Advancements in endoscopic management of small-bowel polyps in Peutz-Jeghers syndrome and familial adenomatous polyposis.

Before the development of double-balloon enteroscopy (DBE), the standard management of small-bowel polyposis was surgical resection. This is an invasive procedure that could lead to short bowel syndrome. In the 21st century, several new enteroscopy techniques were distributed worldwide, including DBE, single-balloon enteroscopy, spiral enteroscopy, and motorized spiral enteroscopy. These devices enable the diagnoses and endoscopic interventions in the entire small bowel, even in patients with a history of laparotomy. In patients with Peutz-Jeghers syndrome (PJS), endoscopic ischemic polypectomy with clips or a detachable snare is the preferred method for managing pedunculated polyps because it is less likely to cause adverse events than conventional polypectomy. Although polyps in patients with PJS always recur, repeat endoscopic resection can reduce the total number and mean size of polyps in the long-term clinical course. Endoscopic reduction of small-bowel intussusception caused by PJS polyps can be successfully performed using DBE without surgery. A transparent hood is useful for securing a visual field during the treatment of small-bowel polyps, and minimal water exchange method is recommended to facilitate deep insertion. Familial adenomatous polyposis (FAP) is a genetic disorder that increases the risk of developing colorectal cancer. Because jejunal and ileal polyps in patients with FAP have the potential to develop into cancer via the adenoma-carcinoma sequence, periodical surveillance, and endoscopic resection are needed for them, not only polyps in the duodenum. In cases of multiple small-bowel polyps in patients with FAP, cold snare polypectomy without retrieval is an acceptable treatment option for polyps that are 10 mm or smaller in size. Additional good pieces of evidence are necessary to confirm these findings because this narrative review mostly includes retrospective observational studies from single center, case reports, and expert reviews.

Unusual Cause of Small bowel Intussusception

Abstract Introduction/Objective Intussusception is uncommon in adults. When it occurs it is usually secondary to a mass lesion. The purpose of this report is to highlight an unusual cause of intussusception. Methods/Case Report A 48-year-old female presented with right lower abdominal pain, nausea, vomiting, and bloating. She didn’t have a bowel movement in 3-4 days. CT of the abdomen and pelvis demonstrated long segment small bowel intussusception in the right abdomen with a lead point mass. The patient subsequently underwent surgical resection. Grossly the specimen consisted of a 30cm segment of small bowel remarkable for two mucosal nodules measuring 1.9 cm and 1.0 cm in greatest dimension. Microscopically the nodules were composed of sheets of discohesive epithelioid cells with marked nuclear pleomorphism and prominent nucleoli, underlying the normal mucosa. Immunohistochemical studies revealed that the tumor cells to be positive for SOX-10 and MART-1and negative for pan-cytokeratin and DOG1. Diagnosis of malignant melanoma was rendered. Results (if a Case Study enter NA) NA Conclusion Intussusception due to malignant / metastatic melanoma is rare but should be on the differential for patients with symptoms of small bowel obstruction and intussusception with a lead point mass.

Management of Intussusception: Follow-up or Reduction?

Objective: In this study, we describe the management and outcome of children with intussusception and analyze the sonographic findings that can be used to differentiate transient, self-limited small bowel intussusception from the cases with an indication for surgery. Material and Methods: We retrospectively reviewed the medical records of pediatric patients with the diagnosis of invagination who had been followed up in the pediatric surgery service between 2012-2017. Results: The median age was 39.5±35.9 (range 2-171) months. Among these patients, 57 (64%) had been followed up without surgery, and the remaining patients (n= 32, 36%) had undergone surgery. The median age of patients who had not undergone surgery was significantly greater than that of the patients who had undergone surgery (52.2±38.4 vs. 16.75±12.6; p&amp;lt;0.001). Twenty (35.1%) patients in the non-surgical group had developed abdominal pain after discharge, whereas none of the patients in the surgical group had developed abdominal pain postoperatively. An analysis of the differences between the groups with respect to the length of the invaginated segment revealed that length of that segment were significantly greater in the surgically managed cases (p=&amp;lt;0.001). A ROC curve based on the length of the invaginated intestinal segment revealed that, 41.5 mm was the best cutoff point for invaginated intestinal length, which resulted in a sensitivity of 68.8% and a specificity of 96.5%. Conclusion: In our study, unlike other studies, the surgical threshold of the invagination length was revised as 4.15 cm. Thus, patients below this value may not have an immediate indication for surgery.

SAT675 GLP-1RA Therapy And Intussusception: A Case Report Of Bowel Telescoping In Anobese Patient After Successful Weight Loss On Therapy

Abstract Disclosure: S. Alqaisi: None. W.R. Doerfler: None. T. Latif: None. A. Bandi: None. Background: Glucagon-like peptide receptor agonists (GLP-1RA) are incretin-based drugs that are now a mainstay in managing type 2 diabetes and obesity, offering added cardiorenal benefits. GLP-1RAs slow gastric emptying and small bowel motility, leading to side effects like constipation, nausea, and diarrhea. Small bowel obstruction (SBO), though not well described in clinical trials, has been reported in observational studies. SBO due to intussusception is a rare condition in adults where one segment of the bowel telescopes into the adjacent segment, potentially causing intestinal ischemia. Although GLP-1RA therapy has not been previously linked to intussusception, we present a patient who developed intussusception while on GLP-1RA therapy for obesity. Case: A 54-year-old female with a history of prediabetes, generalized anxiety disorder, diverticulosis, and total hysterectomy with bilateral salpingo-oophorectomy who was referred for obesity class-I (BMI-33) management considered constitutional given the negative work-up. After an initial weight loss of 40 Ibs with diet and exercise, her success stalled. She was started on medical therapy, initially on orlistat which caused diarrhea, then switched briefly to phentermine-topiramate, that resulted in palpitations and increased anxiety. Hence, liraglutide was initiated, resulting in a further weight loss of 25 Ibs. Three months later, she admitted with left lower quadrant abdominal pain, nausea, vomiting, and diarrhea. Lab tests were unremarkable, and an abdominal CT scan showed an 8.9 cm segment of small bowel intussusception without obstruction. Her symptoms improved after a large episode of emesis and placement of a nasogastric tube. She underwent diagnostic laparoscopy followed by exploratory laparotomy. The entire small bowel length was examined, with no abnormalities found, indicating a transient intussusception. She was discharged on liraglutide. Later, she underwent a follow-up small bowel follow-through that showed normal small bowel features. Liraglutide therapy was discontinued, and she remains symptoms free. Discussion: This case highlights the importance of providers being aware of potential adverse effects, including the rare but serious complication of SBO in patients receiving GLP-1RA therapy. Significant weight and omental fat loss may have led to intussusception in our patient. Thinning of the mesentery and loss of visceral fat oppose less resistance to abdominal peristalsis, increasing the risk of intussusception. While the exact mechanism of GLP-1RA-induced SBO remains unclear, it is postulated that inhibition of intestinal motility may play a role, particularly in patients with pre-existing gastrointestinal neuropathy. Therefore, clinicians should monitor patients for signs of gastrointestinal distress or obstruction and investigate suspected cases promptly for timely management. Presentation: Saturday, June 17, 2023

Small bowel intussusception in an adult, a rare surgical emergency. Case report and literature review

Intussusception or intussusception in the adult corresponds to a rare etiology of intestinal obstruction representing only 0,08 % of abdominal surgeries in the world, unlike its presentation in childhood most of these have an underlying organic cause. We present the case of a 55-year-old middle-aged woman with no underlying pathology who presented with repetitive symptoms of intestinal pseudo-occlusion. With the help of imaging studies, the site of obstruction was visualized and she underwent exploratory laparotomy where small bowel invagination was evidenced due to a tumorous process, resection and anastomosis were performed with a rapid recovery and then small bowel adenocarcinoma was confirmed. In conclusion, we must take into account that this rare pathology could occur in patients with signs of occlusion not so clear in order to offer an effective and timely surgical treatment

Jejuno-Jejunal Intussusception in An Adult-An Unusual Presentation of Malignant Melanoma: A Case Report

Background: Small bowel intussusception is common presentation in children and rare in adults but malignant melanoma as primary cause is once in a blue moon event. It accounts for 1% of all bowel obstructions. Jejuno-Jejunal intussusception is a rare mode of metastatic malignant melanoma presentation. It may be metastatic and rarely primary cause of this type of presentation. In literature no such case s reported from our country before and perhaps seventh case of malignant melanoma as primary cause of jejuno-jejunal intussusception in literature. Case Presentation: Here we report a case of a 40 years old male who presented to us with features of intestinal obstruction. On exploration, Jejuno-Jejunal intussusception was found secondary to some mass in jejunum. Resection anastomosis of Jejunum was performed. Histopathological examination of mass revealed metastatic malignant melanoma. On further work up, CT scan abdomen showed multiple enlarged mesenteric lymph nodes and few enlarged bilateral inguinal lymph nodes. Patient post-operative recovery was uneventful and discharged. Conclusion: One should suspect metastatic melanoma as a lead point in cases of jejuno-jejunal intussusception in adults presenting with intestinal obstruction.