Presentation
Epigastric region pain and vomiting one day before hospitalization.
Patient Data
A rounded mass in the left lumbar at the level of the renal hilum, creating a "target sign."
Axial non enhanced CT: A rounded mass in the left lumbar at the level of the renal hilum (red circle)
Axial CT enhanced portal venous phase: It shows an abnormally dilated bowel loop, with central increased density (intussusceptum - yellow circle) surrounded by mesenteric fat and vessels (green arrow) encased by higher intensity bowel wall of the intussuscipiens (red arrow), creating a "target sign". Also note the continuity of the bowel wall of the intussuscipiens to the adjacent normal loop (yellow arrow and red curves) and a soft-tissue density mass (lead mass), which can be seen clearly in coronal plane (red circle).
Small bowel polyp (size 4 x 2 x 2 cm)
Histology: Adenomatous polyposis, mild dysplasia
Hospital discharge diagnosis: Intussusception/ Multi small bowel polyps
Treatment: Bowel resection
Case Discussion
This is a classic example of a small bowel intussusception in adults.
Intussusception in adults accounts for about 5% of cases of intussusception 1.
Intussusception in children is mostly idiopathic, while a lead point is noted in 70-90% of adult cases 1.
Lead points are usually due to polyps, tumor or scar-like tissue in the bowel 2.