Multiple simultaneous small bowel intussusceptions in an adult
A 41-year-old female presented with 3 weeks of intermittent crampy epigastric abdominal pain, nausea and diarrhea. She was able to tolerate a liquid diet but not solids. She had one episode of vomiting and lost 6 lbs over the course of 3 weeks. Her vital signs, physical examination and laboratory studies were unremarkable. She did not have a history of prior abdominal surgery or malignancy. A CT scan demonstrated two areas of small bowel intussusception (Fig. A and B), without evidence of bowel obstruction or mass. The patient underwent exploratory laparoscopy using a 5 mm 30° camera and two 5 mm working ports. Six separate regions of intussusception within the small bowel were discovered between 55 and 130 cm from the ligament of Treitz. All areas of intussusception were short and witnessed to undergo spontaneously reduction (Fig. A and B), except for one (Fig. ), which was resected through a mini-laparotomy. There was no obvious evidence of masses, adhesions or serosal abnormalities along the small bowel. There were prominent lymph nodes noted in the small bowel mesentery (Fig. ). The postoperative course was uneventful and she was discharged 4 days after her operation. She had resolution of symptoms and had no recurrence after 3 years of follow-up. Pathologic examination of the small bowel demonstrated no evidence of malignancy, lead point, pathologic changes or sprue. Likewise, there was no evidence of acid-fast organisms, fungal or helminth parts identified. The enlarged mesenteric lymph nodes demonstrated reactive follicular hyperplasia and multifocal non-necrotizing lipogranulomas.