do you see a cause for his abdominal complaints?
As observed by the commentators, our pt had an intussusception of the small bowel. A Dutch physician, Barbett, was the first person to refer to intussusception in 1674.
This is an important etiology of abdominal pain to consider in adults. The classic triad of abdominal pain , vomiting and currant-jelly stool found in children is rarely seen, leading to delays in diagnosis. In the case presented by Teng referenced below, a 37 y.o. male had symptoms for five years before the diagnosis was made on CT. When he underwent laparotomy, no intussusception was found; just thickened bowel loops. Presumably it had spontaneously reduced each time he presented. Intussusception accounts for 1-5% of bowel obstructions in adults
In contrast to pediatric intussusceptions which are managed with air contrast enemas, treatment in adults can involve surgery. There is often a lead point for intussusception in adults which can be a tumor and enemas are not recommended because of the fear of perforation and spread of tumor cells.
In children, Henoch Schonlein purpura or hypertrophy of Peyer’s patches can be the lead point of the intussusception. Peyer’s patches hypertrophy in several diseases including prion disease, polio and salmonella. 11% of pediatric intussusceptions reduce spontaneously.
Intussusceptions also reduce spontaneously in adults and that was the case in our patient. A repeat CT showed no abnormality and his symptoms resolved.
Teng L, Chng, U. Adult Intussusception, Perm J. 2015 Winter;19(1):79-81.
Spiridis C, Kambaroudis A, et. al. Intussusception of the small bowel secondary to malignant metastases in two 80 year-old people: a case series. J Med Case Resports 2011;5:176.
Barbette P. Ouevres Chirurgiques at Anatomiques. Geneva: Francois Miege; p. 1674.
Stewardson R, Bombeck C, Nyhus L. Critical operative management of small bowel obstruction. Ann Surg. 1978;187:189-193.