Presentation
Repeated hospital admissions with abdominal bloating and vomiting for more than one year. No prior CT investigation.
Patient Data
Long segment intussusception noted at the proximal jejunum causing subacute obstruction with subsequent proximal grosssly dilated jejunum which appears redundant (reaching up to the pelvis). This stretches the duodeno-jejunal junction along the midline (suggestive of mesenteric laxity) . These findings are compatible with jejunojenunal type of enteroenteric intussusception.
The intussuscepiens shows a segment of mildly thickwalled slightly enhancing intussusceptum of invaginated proximal jejunum with mesenteric fat, vessels and insignificant small lymph nodes. The intussusceptum does not show any obvious mass lesion or lead-point.
The duodenum appears normal . Stomach appears dilated. The adjacent vasculature maintains its normal anatomical axis. No obvious volvulus noted.
The post surgery specimen almost completely conforms to the CT appearance, the jejunum was thickened and diseased and a resection anastomosis was performed. Surprisingly, no lead point was demonstrated.
Case Discussion
An intussusception occurs when one bowel loop (intussusceptum) invaginates into another section of bowel (intussuscipiens), akin to a telescopic movement. It is mainly a childhood disease, however contributes to 1% of all adult intestinal obstructions. When it occurs in adults it is usually associated with a lead point like a neoplasm or polyp with the commonest benign neoplasm being a lipoma.
While ultrasound is the modality of choice in children for the diagnosis of intussusception, in adults, CT is the diagnostic modality . Also, childhood intussusception a have a high rate of spontaneous or post hydrostatic reduction, whereas in adults such cases are surgically corrected.
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