Laparoscopic Management of Intussusception in an Adult

Tejal Pandya, MD, Praneetha Narahari, MD

St. Agnes Medical Center and Dept. of Surgery, UCSF-Fresno

Introduction: Intussusception is rare in adults and accounts for 5% of all Intussusceptions, and less than 1% of bowel obstructions. A lead point, commonly a neoplasm is seen in 80% of adult cases. Accurate diagnosis and early treatment can reduce the risk of bowel infarction and perforation. Surgical treatment is advocated as the lead point may be malignant in 50% of cases. We report a case where the intussusception was treated with laparoscopy with minimal morbidity.

Case Summary: A 47 yr old, obese lady with prior MI and CAD presented to the ER with constant and severe intensity abdominal pain for few hours. She had intermittent abdominal pain for a month. CT scan revealed "Target Sign" with radiolucent 3 cm mass suggestive of intussusception from a lipoma. At laparoscopy, with one 12 mm and 3 x 5mm trocars, the lipoma was identified in the mid small bowel and segemtal bowel resection performed. it was extracted in a sac from the 12 mm trocar. She recovered well and was discharged on POD 4. Pathology revealed a 3 cm benign submucosal lipoma.

Conclusions: Intussusception detection in an adult can be elusive, but prompt diagnosis and expeditious management can reduce the morbidity. Review of literature indicates laparotomy as the choice of procedure for treatment of Intussusception. Laparosocpy offers the advantage of minimal access with excellent exposure and maximal benefit with reduced morbidity. The short term results are obvious with a quicker recovery, lower infection rate and early discharge. The long term benefits of early return to work and and reduced adhesions are well documented.