Presentation
Acute-onset left iliac fossa pain with associated nausea and vomiting.
Patient Data
Findings:
- in the left flank extending into the left iliac fossa is an enteroenteric intussusception with some adjacent fat stranding but no evidence of ischemia or obstruction
- feces present in distal and terminal ileum
- some swirling of small bowel loops in pelvis, one in particular making a "ring appearance"
- no ascites or intra-abdominal free air
- no pathologically enlarged abdominal, pelvic or inguinal lymph nodes
Conclusion:
- left flank/iliac fossa enteroenteric intussusception without any evidence of ischemia or bowel obstruction
Case Discussion
50-year-old presenting with acute onset left iliac fossa pain with associated nausea and vomiting. He gave a history of rheumatoid arthritis recently commenced on leflunomide (disease modifying anti-rheumatic drug).
CT scan performed in the emergency department showed enteroenteric intussusception.
The patient underwent a diagnostic laparoscopy which showed normal small bowel and resolved intussusception. The patient had an outpatient magnetic resonance enterography and colonoscopy which were normal.
Impression: resolved intussusception with no obvious cause seen on diagnostic laparoscopy, colonoscopy and magnetic resonance enterography.
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