Journal of Radiology
Open Access

A 77-year-old male patient consulted the emergency department with a cessation of matter and gas for 3 days in association with abdominal pain, melena, vomiting as well as abdominal distension.

The clinical examination showed an important abdominal distension as well as signs of dehydration however, the patient was stable on respiratory and hemodynamic plans and there was no fever. His biological workup didn’t show any abnormalities.

Imaging with abdominal X-rays without preparation showed diffuse gaseous distribution of the large bowel, however, there was no gas in the pelvic area (Figure 1).

Figure 1: Imaging with abdominal X-rays without preparation showed diffuse gaseous distribution of the large bowel, however, there was no gas in the pelvic area.

Then the patient underwent an abdominal CT with contrast enhancement (portal) that showed a large bowel occlusion secondary to intussusception of the left colon (Figure 2).

Figure 2: Abdominal CT scan with contrast enhancement (portal) that showed a large bowel occlusion secondary to intussusception of the left colon.

The patient went immediately to the operating room, where the diagnosis was confirmed.

Discussion

Intussusception affects children 20 times more frequently than adults.

Adult intussusceptions represent 5% of all intussusceptions [1] and 1–5% of bowl occlusions in adults [2]. It happens when one segment invaginate into the immediately adjacent segment; it affects more frequently the small bowel and less frequently the large bowel.

An intussusception loop is defined by its head (lead point) and neck. As opposed to children, this lead point in adults contain more often a pathological lesion, any abnormality the disrupt the bowel peristalsis can cause intussusception, most of it cause by a lead point -1-, which can be neoplasm, diverticula, intestinal ulcer, this lead point is initially caught by adjacent segment, the pulled further by peristalsis. Primary intussusception (without a pathological lead point) in adults is present in only 8–20% of cases [3].

Pain is the most frequent symptom, which can occur up to 80% of the time, as described by several studies [4,5].

Other symptoms include abdominal tenderness. Usually, fever is an indicator of intestinal necrosis. In addition to symptoms of parietal peritoneal irritation, failure to pass gas, abdominal lumps, and diarrhea, even with bloody stool, decreased or missing bowel sounds may also be present.

CT scan is considered the gold standard for diagnosing intussusception, as it can highlight the location, lead point, as well as signs of complications (necrosis, perforation).

Pathognomonic radiological aspects of intussusception are represented by “the target sign” or “concentric ring sign” on axial reconstruction (Figure 1) or “the sausage shape” on longitudinal reconstruction (Figure 3).

Figure 3: Abdominal CT scan with contrast enhancement that showed a large bowel occlusion secondary to intussusception of the left colon: “the sausage shape” on longitudinal reconstruction.

As was previously mentioned, a pathologic lead point frequently contributes to adult intussusception. For those reasons, as opposed to the pediatric population, surgery has traditionally been used to treat intestinal intussusception, which results in obstruction. The attempt of hydrostatic reduction in the adult population is not recommended; on the other hand, in the pediatric population, this is the preferred course of therapy in most circumstances; in fact, the proportion of surgical treatment in this later age group is so much lower than 10% of the reported instances [6].

Conflict of Interest

The authors declare no competing interest.

Contributions

All authors contributed equally in this work.

Funding statement

The authors received no specific funding for this work.

Patient consent statement

Informed consent for patient information to be published in this article was obtained.

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