A 31 y.o male presents with abd pain

What do see on the CT?

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Our pt had an intussusception of the small bowel into the colon and the right colon intussuscepted into itself.  At surgery , it was not able to be reduced and a right hemicolectomy was performed. A  3 cm inflammatory polyp was found to be the lead point of the intussusception.

 intussuscepted bowel

intussuscepted bowel

The cause of intussusception is unknown in children.Iit can present with currant jelly stools and can often be reduced with an enema. Risk factors in children include  cystic fibrosis and intestinal polyps. The usual age of intussusception in children is 6-18 months.   In adults,  there is often a lead point is present and the most common causes are endometriosis, bowel adhesions and tumors.  Meckel’s diverticulum, duplication cysts and hyperplasia of the Peyer’s patches can also cause intussusception.

 In the most frequent type of intussusception, the ileum enters the cecum.The part that is contained within bowel is the proximal part of the bowel since peristalsis carried it forward.  The trapped bowel may become ischemia necessitating surgical intervention.

 Intussusception caused by a  J tube

Intussusception caused by a  J tube

Our patient had a second bowel obstruction after surgery which was managed conservatively and thought to be secondary to an adhesion.  He was discharged after resolution of his symptoms and is doing well. The cause of his polyp was felt to be heavy NSAID use.

Marsicovetere T, Ivatury, et al. Intestinal intussusception: etiology, diagnosis and treatment. 2017 Clinics in colon and rectal surgery 30(1):30-39

Gluckman S, Karpelowsky J, et al. Management for intussusception in children. The Cochrone Database of Systematic Reviews.  6:CD006476.

Gayer G, Zissin R, Apter S, PapaM, Hertz M. Pictorial review: adult intussusception—a CT diagnosis. 2002  Br J Radiol. 75(890): 185-90