Small bowel intussusception

Case contributed by Dr Kenny Sim

Presentation

Severe colicky abdominal pain. Past history of gastric bypass surgery with Roux-en-Y loop.

Patient Data

Age: 45
Gender: Female
Modality: CT

 

Within the left abdomen, there is a long segment of small bowel intussusception with the upstream small bowel fluid filled and dilated. The intussusceptum is thickened and oedematous, and there is a short segment of the intussusceptum that is non-enhancing, representing ischaemia/infarction. 

Small bowel mesenteric fat and vessels are appreciated being pulled in along with the intussusceptum. No lead point mass is confidently identified. The anastomotic suture ring of the intussuscipiens does not appear to be the lead point.

Evidence of previous gastrojejunostomy and entero-enterostomy. There is a small pocket of free intraperitoneal fluid lying anterior to the point of intussusception. No pneumatosis intestinalis or portal venous gas identified.

Case Discussion

The patient went for emergency laparotomy, which demonstrated the efferent limb of the Roux-en-Y intussuscepting into the afferent limb beyond the entero-enterostomy anastomosis. Approximately 10cm of infarcted small bowel was identified and resected. No focal lead point mass was identified.

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Case Information

rID: 39128
Case created: 21st Aug 2015
Last edited: 14th Aug 2016
Inclusion in quiz mode: Included

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