A 61-year-old woman presented with 4 days of subacute generalized abdominal pain, associated nausea, and 4 episodes of coffee ground emesis. She had a gastrojejunostomy 35 years previously. An intravenous and oral contrast abdominal/pelvic computed tomography (CT) showed a large lobulated mass with small bowel morphology within the stomach suggestive of a duodenal and proximal small bowel intussusception into the stomach and subsequent incarceration (Figure 1 and Figure 2). The intussusception was laparoscopically reduced and adhesionolysis was performed.
Figure 1. Abdominal/pelvic CT showing a large retrograde jejunogastric intussusception with intragastric strangulation of jejunal loops via a gastrojejunostomy (yellow arrows). The stomach is distended with oral contrast (green arrows).
Intussusception, which accounts for 1% of bowel obstructions in adults, is described when a proximal loop of bowel (intussusceptum) telescopes into the lumen of adjacent distal bowel (intussuscipiens).1 Intussusception is most common in the pediatric population and can occur in any part of the bowel. In adults, the main risk factor for intussusception is prior surgery or intervention, and idiopathic intussusception is uncommon, occurring in 8-20% of cases.2 Adults typically present with non-specific symptoms, and 90% have an associated lead point.3 Diagnosis is often difficult, and abdominal CT is the gold standard diagnostic test in adults, while ultrasound the diagnostic standard in children.
Figure 2. Axial pelvic CT showing a large retrograde jejunogastric intussusception with intragastric strangulation of jejunal loops via a gastrojejunostomy (arrows).
Author contributions: All authors participated equally in manuscript creation.
Financial disclosure: None to report.
Informed consent was obtained for this case report.
Correspondence: Ciara O’Brien, Radiology SPR, Tallaght Hospital, Dublin 24, Ireland (firstname.lastname@example.org).
Received October 14, 2015; Accepted December 3, 2015
- Azar T, Berger DL. Adult intussusception. Ann Surg. 1997;226(2):134–8. PubMed
- Govednik C, Cover J. Regner JL. Preventing retrograde jejunoduodenogastric intussusception as a complication of a long-term indwelling gastrostomy tube. Proc (Bayl Univ Med Cent). 2015;28(1):34–37. PubMed
- Bhattarai A, Poudyal S, Bhandari RS, Lakhey PJ, Singh KP. A retrospective study of intussusception of the bowel in adults. J Inst Med. 2015;37(1):98–103.
© 2016 O’Brien et al. This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-nd/4.0.