Intussusception in gravida

Case contributed by Dr Yair Glick

Presentation

Upper abdominal pain in a 32-week pregnant woman.

Patient Data

Age: 35 years
Ultrasound

Large amount of free fluid in left paracolic gutter and between intestinal loops.
Aperistaltic, dilated intestinal loops in left abdomen, mainly in upper quadrant, with markedly thickened walls (up to 1.6 cm thick) exhibiting stratified appearance. No blood flow demonstrated in intesinal walls.

CT

Arterial phase (not shown) and late venous phase CT:

Gravid uterus, advanced pregnancy.
In left abdomen, there is a small bowel loop containing a small bowel loop and mesentery which shows mild fat stranding. Bowel wall in said loops is markedly thickened. Proximal to intussuscept, jejunum and stomach are dilated and filled with contrast material. Fluid in left paracolic gutter.

Case Discussion

The woman was rushed to the OR for exploratory laparotomy. The surgical report was as follows: "Intussusception of a long segment of jejunum, at least 50 cm in length. Following its release, an ischaemic segment was revealed with a haemorrhagic wall and abscence of pulse. In addition, a large 3-cm polyp was palpated in the proximal bowel. Moderate amount of serotic fluid in the abdominal cavity. Proximal small bowel markedly dilated, up to 5-6 cm. [...] 70 cm of jejunum excised. End-to-end anastomosis. [...] Small incision over jejunal polyp and excision of polyp with long stalk."

As bowel ischaemia requires emergent surgery, abdominal CT can be justified in pregnancy. Of note, the hospital did not have an MRI machine at the time.

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Case information

rID: 53394
Case created: 16th May 2017
Last edited: 30th May 2017
Inclusion in quiz mode: Included

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