Adult Intussusception in a Referral Hospital in Sub-Saharan Africa: Case Report and Literature Review

Abstract

Introduction: Adult intussusception is a rare form of bowel obstruction which constitutes less than 5% of all cases of intussusception. In Sub-Saharan Africa, adult intussusception is not a rare cause of bowel obstruction. It is usually caused by a lead point which may be malignant in up to 50% of cases unlike childhood intussusceptions which are usually idiopathic. The author reports on a case of intussusception followed by a literature review on the pathogenesis and treatment options for intussusception in Sub-Saharan Africa. Presentation of Case: A 46 year old gentleman presented with nonspecific abdominal symptoms mainly with epigastric pain associated with vomiting. No palpable masses were felt in the abdomen. Laboratory investigations were unremarkable. At laparotomy an ileo-ileal-caecal intussusception was found and when reduced 30 cm of ileum resulted gangrenous. A limited resection of the small bowel with end-to-side anastomosis involving the viable ileum and ascending colon was carried out. A lobulated lipoma was the pathological lead point on inspection of the ileum in the resected specimen. Discussion: The atypical clinical features and pathogenesis of adult intussusception are described in the case presented. In addition, this study reviews the literature regarding the pathogensis, clinical features, diagnostic imaging modalities and treatment options of adult intussusception. Conclusions: Patients with long standing abdominal pain and vomiting should have an abdominal CT scan to achieve a clear diagnosis of intussusception. This will avoid any unnecessary delays in the operative management of this condition.