Barbette is rare in adults with a child to

Barbette reported the first case of intussusception in Amsterdam in 16742. This was then further elaborated  in 1789 by John Hunter 3. Sir Jonathan Hutchison performed the first surgery on a child with intussusception in 1871.4 This disease has long been considered one of infancy and early childhood. It is rare in adults with a child to adult ratio of nearly 20:15. Adult intussusception thus represents 5% of all intussusception and accounts for 1-5% of intestinal obstruction in adults6. In children, nearly 80% are idiopathic whereas in adults a defined aetiology is always found in 90% of cases7. Most of the structural lead points in adults are malignant neoplasms, responsible for 66% of Colonic intussusception and 30% of small bowel intussusception. The most common malignant lesion is Colon Adenocarcinoma, whereas metastasis are usually responsible for intussusception of the small bowels8, 9. Other lesions incriminated include, Adenomatous polyps, Lipomas, Fibromas, Harmatomas, Adhesions from previous surgery, Cystic fibrosis, Scleroderma, Coeliac disease, Inflammatory bowel disease, Appendicitis and rectal foreign bodies. Sixteen Per cent of small bowel and 5% of large bowel intussusception are idiopathic10. Intussusception are classified according to their location into four categories: Entero-enteric, confined to the small bowel; Colo-colic, involving the large bowel only; Ileo-colic and Ileo-caecal, where the lead point is the ileo-ceacal valve7. Most case reports reviewed on Google Scholar and Pubmed were Ileo-colic and had a well determined etiology be it intestinal lipoma, malignancy, Crohn’s desease, Merkel’s diverticulum or other benign intestinal lesions7, 10–12. Very few cases of idiopathic adult intussusception have been reported. Most of these cases were uncomplicated and chronic in presentation. Our case was peculiar in that it is an entero-enteric idiopathic intussusception presenting with two complications: bowel obstruction and perforation/peritonitis.Clinical presentation of intussusception in adults is diverse, with the triad of cramping abdominal pains, currant-jelly stools and a palpable tender abdominal mass very rare. The presenting symptoms in adults are nonspecific with majority of cases being reported as chronic, consistent with partial bowel obstruction6, 7. Chronic intermittent cramping abdominal pains, nausea, vomiting, GI bleeding (especially in the elderly), constipation are usually the presenting complaints in adults10, 13. Our patient however came in with an acute presentation due to the complications which already ensued. Our patient equally never reported episodes of abdominal pains nor constipation nor vomiting in the past. We therefore had a case of a sudden onset of bowel intussusception in an adult of unknown aetiology.Abdominal CT-scan is the goal standard for the diagnosis of adult intussusception. A soft tissue intestinal mass with an outer intussuscipiens and a central intussusceptum appearing as a “target” or a “sausage-shaped” is the pathognomonic CT-scan sign10, 14. Other imaging techniques may equally be helpful; Air-fluid levels on a plain abdominal X-ray if there is already obstruction and the “doughnut sign” on abdominal sonography if done at the early stages. These 2 last techniques however have low sensitivity and despite the fact that the later is cheap and readily available, it is operator dependent and difficult to interpret in the presence of gaz especially when there is bowel obstruction5, 15. Our patient presented with clinical peritonitis and anguishing abdominal pains, hence further imaging investigations were not dimmed necessary given the fact that the diagnosis of peritonitis is mostly clinical. Given that the aetiology and diagnosis of adult intussusception is often vague and taking into cognisance the high incidence of malignancy as aetiology, the preferred treatment is usually bowel resection during an exploratory laparotomy an

x

Hi!
I'm Homer!

Would you like to get a custom essay? How about receiving a customized one?

Check it out