Intussusception in Adults: A Rare Etiology of Small Intestinal Obstruction.

ABSTRACT

Small intestinal obstruction is a common surgical emergency that has a wide range of underlying etiologies. The most frequent causes of small intestinal obstruction include adhesions, hernias, and malignancies. The diagnosis of small intestinal obstruction is primarily dependent on the clinical findings, but imaging investigations are crucial to confirm the diagnosis and evaluate the complications. We report the case of a middle-aged woman with a complaint of abdominal pain for one week that was associated with abdominal distension and decreased bowel motion. Examination of the abdomen showed a distended abdomen. There was generalized tenderness, but no guarding or rigidity was noted. Initial laboratory investigation showed no derangement in the basic hematological and biochemical parameters. Abdominal CT was performed, which showed a segment of jejunojejunal intussusception causing a small intestinal obstruction. There was a well-defined, oval-shaped fat-attenuation mass lesion acting as a lead-point. Such radiological findings conferred the diagnosis of jejunojejunal intussusception due to jejunal lipoma. The patient underwent laparotomy, which confirmed the radiological finding. The intussusception was reduced, but a gangrenous intestine was observed. Resection of the affected intestine was performed, followed by a primary anastomosis. The patient recovered with no complications. Following the operation, oral feeding was started gradually according to the patient's tolerance. She was discharged after 10 days of hospitalization. At the follow-up visit after three months, the patient had no active symptoms. This case illustrated a rare etiology of small intestinal obstruction due to gastrointestinal lipoma. A computed tomography scan is strongly advised to reach the diagnosis and identify the lead points.