Idiopathic Intestinal Intussusception: A Case Report and Literature Review

Abstract

Adult intussusception is uncommon and differs clinically from paediatric disease because most adult cases are associated with an identifiable pathological lead point. Idiopathic adult intussusception, particularly in the small bowel, remains incompletely understood, and management is not standardised. We report a 44-year-old man who presented to the emergency department with vomiting and worsening abdominal pain following several weeks of vague abdominal pain. Examination demonstrated upper abdominal tenderness, non-specific hyperactive bowel sounds, tachycardia of 125 beats/min and blood pressure of 108/82 mmHg. Laboratory testing showed a white blood cell count of 9,400/mm³ and C-reactive protein of 104 mg/L. Abdominal radiography demonstrated air-fluid levels, and computed tomography revealed small bowel obstruction due to ileo-ileal intussusception, without bowel ischaemia or perforation, with segmental intralesional bowel wall thickening thought to be inflammatory. Exploratory laparotomy identified ileo-ileal intussusception approximately 2.40 m distal to the initial jejunal loop. No perforation, intra-abdominal fluid collection or pseudomembranes were observed. Ileal resection with temporary ileostomy was performed. The postoperative course was uncomplicated; bowel movements resumed on postoperative day 1, and the patient was discharged on postoperative day 2. Histopathological examination confirmed small bowel intussusception and showed congested but non-neoplastic resection margins, with no malignancy. Intestinal continuity was restored one month later, and follow-up was unremarkable. This case supports consideration of adult intussusception in patients with obstructive symptoms, even when no malignant lead point is found. It also illustrates the importance of correlating imaging, operative findings and histopathological assessment in suspected idiopathic small bowel intussusception.