A Case of Idiopathic Intussusception in an Adult with Small Bowel Volvulus

Abstract

A 79-year-old female, whose past history was unremarkable, complained of constipation and anorexia. A diagnosis of intestinal obstruction was made on the basis of a plain abdominal X-ray film and she was admitted to our hospital after insertion of an ileus tube. Laboratory data on admission revealed mild elevation of WBC count, CRP, Hb, Ht, and BUN levels, but there were no other abnormal findings. A subsequent abdominal Xray showed that the volume of intestinal gas had decreased, but the tenderness in the right lower abdomen was not improved. Three days after admission, she was diagnosed as having intussusception of the terminal ileum with abdominal ultrasound and CT, which showed the “target sign”. An emergency operation was thus performed. Operative findings disclosed 13cm intussusception of the terminal ileum distal to Bauhin.s valve accompanied by small bowel volvulus; the small bowel was twisted 270° counterclockwise. A slight ischemic change of extensive small bowel was seen, but no gangrenous small bowel was detected, so the volvulus was able to be rotated back to the correct position. An ileocecal resection was performed because a portion of the intussuscepted intestine had already exhibited severe ischemic change. The patient had favorable progress after the operation and was discharged on the 15th postoperative day. In this case, small bowel volvulus could be induced by an indwelling ileus tube.