Ifeoma P. Kwentoh, MD, Gumbs Shamon, MD, Brian P. Donaldson, MD Harlem Hospital Center, New York, NY
Introduction: Adult intussusception is extremely uncommon, even more so is transient jejunal jejunal intussusception which may occur without a radiological lead point in about 8 to 20 percent without evidence of mechanical bowel obstruction [1]. Transient jejunal jejunal Intussusception has very limited case reports in Literature and has been considered by some experts as a diagnosis of exclusion due to its rarity [2,3].
Case Description/Methods: A 53-year-old woman with history of treated ovarian cancer 2004, now in remission, presented with refractory right lower quadrant pain (RLQ), hematochezia, nausea, and vomiting unrelated to food. She was referred to gastroenterology for evaluation for her intermittent bouts of RLQ abdominal pain which began 4 years prior and a new onset hematochezia. On examination she appeared well-developed and well-nourished, in no acute distress and anicteric. Contrast computed tomography revealed jejunojejunal intussusception without visible lead point and post radiation treatment of ovarian cancer changes from radiation. A repeat Imaging study was recommended which showed resolution following symptomatic “Wait and watch” approach. The etiology of her abdominal pain remained elusive until the imaging was done.
Discussion: There are generally 3 categories of adult intussusception (i)Persistent intussusceptions leading to acute abdomen and requiring urgent surgical resection, (ii) Transient symptomatic intussusceptions as our patient that may be amenable to a 'wait-and-see' option and (iii) transient asymptomatic intussusceptions involving small bowel. All previously reported cases were either secondary to a malignancy or benign . To the best of our knowledge this may be the first presentation with Hematochezia and remote pelvic cancer. The diagnosis of adult transient Intussusception remains one of exclusion and CT scan is the gold standard [1-3].
Figure: Figure 1A: CT abdomen - Jejunal jejunal intussusception measures 3.2 cm at the left upper abdomen Yellow Arrows. 1B: (coronal section); showing a segment of small bowel loop. Yellow thick arrow
Disclosures:
Ifeoma Kwentoh indicated no relevant financial relationships.
Gumbs Shamon indicated no relevant financial relationships.
Brian Donaldson indicated no relevant financial relationships.
Ifeoma P. Kwentoh, MD, Gumbs Shamon, MD, Brian P. Donaldson, MD. P4951 - Transient Adult Jejunojejunal Intussusception Associated With Hematochezia: A One Patient Experience!, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
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