Presentation
Vomiting and blood-stained stool.
Patient Data
Multiple (counted three) oedematous segments of the bowel loops with loops within loops appearance of the respective intussuscipiens and the intussuscepta, are noted at the supra-umbilical region, at right para-umbilical region and at the left iliac fossa region with the mentioned segmental bowel areas showing pseudokidney semblances on transverse planes. Colour Doppler reveals normal vascularity within the layers of the bowel loops. Minimal clear intra-peritoneal fluids is noted.
Case Discussion
Simultaneous multiple telescoping of the segments of the bowel with bowel-within-bowel appearances. One of the intussusceptions (at the supra-umbilicus) exhibit submarine sandwich resemblance while the latter two counterparts maintaining doughnut sign (a.k.a pseudokidney) appearance. No gross lymphadenopathy or significant peristalsis. Simultaneous multiple intussusceptions are quite rare and normally doubles up in severity in intestinal obstructions unlike if only one occurred.
Surgical exploration revealed ileocolic intussusception from the terminal ileum to the descending colon with clear peritoneal fluid. Also noted were two perforations (one at the hepatic flexure and one at the descending colon). A gangrenous segment at the terminal ileum (approximately 10 cm in length) plus mesenteric lymphadenopathy (likely the cause of the intussusceptions) were noted.
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