An ileo-ileal idiopathic adult intussusception: diagnostic and therapeutic challenges from the emergency department: a case report.

backgroundWith this case report, we aim to draw attention to intussusception as a potential differential diagnosis in the emergency department for adults with diffuse abdominal pain and emphasize the importance of imaging studies in establishing a diagnosis and how to recognize the disease owing to possible serious and life-threatening consequences. CASE PRESENTATION: From the emergency department, intussusception was diagnosed in an adult, Caucasian, Croatian, male patient with a history of arterial hypertension and without a history of underlying intestinal disease. Family history was also without serious diseases. The 67-year-old Caucasian, Croatian, male patient presented to the emergency department with acute diffuse abdominal pain, nausea, acid regurgitation, and vomiting for the past 3 days. Laboratory results revealed leukocytosis, microcytosis, anisocytosis, and hypochromia. The serum C-reactive protein level was 181.9 mg/L. The native abdominal X-ray showed ileus of the small intestine. The patient was urgently referred for an abdominal computerized tomography scan, which showed dilated loops of the small intestine up to the transition zone in the ileum, where there was a target sign and kidney sign (intestinal loops within the lumen of another intestinal loop), indicating ileo-ileal intussusception. The described condition required urgent surgical intervention. A resection of the affected part of the small intestine (ileum) with an end-to-end anastomosis was performed, and a sample was sent for pathological examination. A histopathological diagnosis report corresponded to the referral clinical diagnosis: K56.2 Intussusception and volvulus of the ileum. The patient recovered successfully and was discharged for home care after several days.

conclusionAlthough intussusception occurs in children in 95% of cases, it is important to consider intussusception in adults as a life-threatening condition. In our case, the adult, Caucasian, male patient presented to the emergency department with diffuse abdominal pain, accompanied by nausea and vomiting. Imaging confirmed a serious condition: in this case, an abdominal computerized tomography scan verified small bowel dilatation with the characteristic target sign and kidney sign (bowel loops within the lumen of another bowel loop), which radiomorphologically confirms ileo-ileal intussusception. Surgical therapy was indicated. Thanks to the prompt and timely intervention of the emergency department physician as well as timely radiological diagnostics, the potentially threatening condition presented by our patient was quickly diagnosed, and the patient was successfully treated.