A 22‐year‐old man was admitted with intractable nausea, vomiting, and abdominal pain for 7 hours. He was visiting New Orleans and reported consuming 4–6 beers prior to onset. He described the pain as 10/10 nonradiating epigastric and right upper quadrant aching that waxed and waned. He described 4 similar episodes over the previous 2 years, one 4 months earlier requiring hospitalization. He was diagnosed with mild gastritis by esophagogastroduodenoscopy. Symptoms improved after discharge, but he reported vomiting weekly since. He denied association of symptoms with eating, history of gastroesophageal reflux, peptic ulcer disease, diabetes mellitus, abnormal stools, or diet changes. Bowel sounds were normal with no organomegaly. There was tenderness to palpation in the epigastric area and right upper quadrant and no Murphy's sign or guarding or rebound. White blood cell count was mildly elevated with normal liver function tests and total bilirubin. Lipase was normal, and abdominal x‐ray showed no obstruction or calcifications. Ultrasound showed no gallbladder abnormalities or biliary tree. He was given nothing by mouth and started on IV pantoprazole and ondansetron with aggressive IV fluids, yet his nausea and vomiting worsened. Serum H. pylori testing was negative. CT with contrast revealed multiple jejunal intussusceptions without obstruction. Following surgical consultation, a nasogastric tube was set to intermittent suction. Symptoms improved. Abdominal CT showed resolution of intussusception. With stable symptoms, he was discharged for close follow‐up at a medical center in his hometown.
Hospitalists commonly encounter abdominal pain complaints. However, intussusception is a rare etiology among adults, accounting for 5% of cases. Although the cause is usually benign and can be managed nonsurgically in the pediatric population, malignancy causes about 65% of adult cases. Other causes include inflammatory bowel disease, colonic diverticula, adhesions, and polyps. Transient, nonobstructing intussusception can occur in both celiac disease and inflammatory bowel disease, frequently self‐resolving. Up to 28% of adult cases are idiopathic. Intermittent abdominal pain is the most common symptom, as well as nausea, vomiting, melena, fever, and constipation. Most adults report prior episodes of intermittent abdominal pain and vomiting. Abdominal CT, the most sensitive imaging modality, shows a characteristic target or layered sausage‐shaped mass, as seen in this patient. CT can identify a lead point, not seen here. In some cases, lower endoscopy can identify a causative lesion. Initial diagnosis is often missed and only found in surgery (required in 70%–90% of cases). Nonsurgical reduction is possible if malignancy is not suspected and bowel is viable.
With potentially intermittent symptoms, it is important for physicians to consider this rare but life‐threatening etiology in their differential diagnosis of previously unexplained abdominal pain.
To cite this abstract:Bennani Y, Bhatnagar D. This Isn't Child's Play: Transient Intussusception in Adults. Abstract published at Hospital Medicine 2013, May 16-19, National Harbor, Md. Abstract 212. Journal of Hospital Medicine. 2013; 8 (suppl 2). https://www.shmabstracts.com/abstract/this-isnt-childs-play-transient-intussusception-in-adults/. Accessed July 23, 2019.