Case Report

Adult Postoperative Intussusception: A Rare Cause of Small Bowel Obstruction

Authors: A. P. Zbar, MD, MBBS, FRCS, FRACS, FCCS, F. Murphy, MBBS, S. M. Krishna, MBBS, DM (RADIOL)

Abstract

A case is reported of postoperative jejunojejunal intussusception in a 45-year-old Afro-Caribbean male following an emergency truncal vagotomy and pyloroplasty. This is a rare cause of postoperative small bowel obstruction, and the pathogenesis and diagnosis of postoperative intussusception in the adult is discussed. Differences between conventional childhood, postoperative childhood, adult, and postoperative adult intussusception are outlined.


Key Points


* Postoperative intussusception in the adult is rare and may have no leading point.


* It differs from non-postoperative intussusception where there is almost always a cause with half of the small and large bowel cases occurring because of an underlying gastrointestinal malignancy.


* Diagnosis of adult postoperative intussusception is difficult where the suspicion of diagnosis is considered by ultrasonography, CT scanning, or barium meal.


* The management is surgical where simple reduction without resection is advocated but is controversial.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Azar T, Berger DL. Adult intussusception. Ann Surg 1997;226:134–138.
 
2. Barussaud M, Regenet N, Briennon X, et al. Clinical spectrum and surgical approach of adult intussusceptions: a multicentric study. Int J Colorect Dis 2006;21:834–839.
 
3. Agha FP. Intussusception in adults. AJR Am J Roentgenol 1986;146:527–531.
 
4. Kjellstrom BT, Gortz L, Nilsson S. Adult idiopathic enteric intussusception in the postoperative period: case report. Eur J Surg 1991;157:359–360.
 
5. Sedgwick CE, Vernon JK. Jejunojejunal intussusception: an unusual complication after pancreatodudoenectomy. Am J Surg 1970;119:752–753.
 
6. Duncan A, Phillips TF, Sciafani SJ, et al. Intussusception following abdominal trauma. J Trauma 1987;27:1193–1199.
 
7. Hunter JG, Schwartz ME, Kim US. Postoperative intussusception after vaginal vault suspension. Am J Obstet Gynecol 1986;154:633–634.
 
8. Wu TH, Lin CW, Yin WY. Jejunojejunal intussusception following jejunostomy. J Formos Med Assoc 2006;105:355–358.
 
9. Olcay I, Zorludemir U. Idiopathic postoperative intussusception. Z Kinderchir 1989;44:86–87.
 
10. deVries S, Sleeboom C, Aronson DC. Postoperative intussusception in children. Br J Surg 1999;86:81–83.
 
11. Ward HC, Brereton RJ. Intussusception and duodenal atresia: an infrequent but expected association. Eur J Pediatr Surg 1992;2:239–240.
 
12. Loizou MC, Koundourakis SS, Kollias VD, et al. Jejunojejunal intussusception after Roux-en-Y gastrojejunostomy: a rare cause of postoperative bowel obstruction in an adult: case report. Eur J Surg 1994;160:451–452.
 
13. Edwards MA, Grinbaum R, Ellsmere J, et al. Intussuscep tion after Roux-en-Y gastric bypass for morbid obesity: case report and literature review of rare complication. Surg Obes Relat Dis 2006;2:483–489.
 
14. Beek FJ, Rovekamp MH, Bax NM, et al. Ultrasound findings in post-operative jejunojejunal intussusception. Pediatr Radiol 1990;20:601.
 
15. Cerro P, Macrini L, Porcari P, et al. Sonographic diagnosis of intussusception in adults. Abdom Imaging 2000;25:45–47.
 
16. Knox AM, Donovan DA, Wilkinson MR. The CT appearances of jejunojejunal intussusception. Australas Radiol 1990;34:264–265.
 
17. Reymond RD. The mechanism of intussusception: a theoretical analysis of the phenomenon. Br J Radiol 1972;45:1–7.
 
18. McGovern JB, Gross RE. Intussusception as a postoperative complication. Surgery 1968;63:507–513.
 
19. Youssef S, Jadaine M, Sakhri J, et al. Invagination intestinale après vagotomie chez l'adulte. Ann Chir 2001;126:786–788.
 
20. Thompson DG, Ritchie HD, Wingate DL. Patterns of small intestinal motility in duodenal ulcer patients before and after vagotomy. Gut 1982;23:517–523.