ADULT INTUSSUSCEPTION DUE TO AN INFLAMMATORY FIBROID

POLYP-A CASE REPORT

ABSTRACT

Adult Intussusception is a rarely found problem. A case was reported in Surgical Emergency of

Allied Hospital Faisalabad. A 70 years old patient having different GIT complaints was observed

with pulse rate of 96/min and blood pressure 120/80 mmHg. After his management surgery

(laparotomy) was planned. Histologically, an inflammatory fibroid polyp was found. The patient

was discharged on the 5th post-operative day because post-operative recovery was uneventful.

INTRODUCTION

Intussusception is a medical disease commonly present in children, but it is also infrequently

present in adults. Intussusception is common in 80% in children less than two years of age while

in adult it accounts 5-10% of all cases. In children, clinical presentations are abdominal pain,

jelly like stool, vomiting and bloody stool. Though, in adults it is usually asymptomatic and the

frequent symptom is abdominal bloating. It is reported that nearly 5% of all intussusception is

present in adults. and it is the most common cause of bowel obstruction in adults [1-3]. Although

it is rarely present in adults, most cases are the result of some medical conditions like tumors

(52%). However postoperative causes accounts (36%), and idiopathic causes (8%) [1, 3,4] . Here

we are presenting a case of adult intussusception because of inflammatory fibroid polyp.

CASE REPORT

An old man aged 70 years came to Surgical Ward with presentation of vomiting and pain in

abdomen from three months and suffering from abdominal bloating and constipation from three

days. Patient was confessed for treatment for two times but recurrence of symptoms. Patient

started to take treatment for tuberculous on Physician instruction.

On Examining the Pulse Rate; it was 94/min and Blood Pressure was 110/80mmHg. Non-tender

and distended Abdomen was found. Bowel Sounds were not audible. No pathological changes

were found on digital rectal examination. Laboratory investigations were normal such as Renal

function test, Complete Blood Picture, Liver Function Tests and Serum Electrolytes. USG

interpretation showed dilated Bowel with fecal loaded with listless back and forth interloop fluid.

X-ray interpretation showed widened jejunal loops with numerous air fluids seen (Fig. 2).

Electrolytes replacement, NG decompression and I/V Fluids was administered to patient. But

patient got no cure. So, the case was managed surgically (Fig. 1). On Laparotomy it was found

that Caecum was collapsed, Ileoileal intussusception was present which was approximately two

ft. proximate to Ileocecal junction with dilated small intestine proximate to that and obstructed

gut distal to that. Part of ileum with intussusception resected and mainly anastomosed as manual

lessening was inconceivable.

Macroscopic examination showed polyps of 3x3 cm size with narrow stalk and on histological

examination, it proved to be inflammatory fibroid poly. Postoperative revival was monotonous

and patient got discharge from hospital on 5th day of surgery.

DISCUSSION

Intussusception is a rare medical condition present in adults. It occurs 1% in adult [4,5]. It is a

surgical condition in adults. The nature of surgical process depends upon patient's clinical history,

(malignancy, prior operations) and the intra-operative conclusions [6, 7].

IFPs are the benign condition occurring in any part of GI tract. They usually originate from

submucosa as having inflammatory source. They may originate or occur in any part of the

gastrointestinal tract but most commonly occur in antrum of stomach and small bowel. IFPs

generally size in between 2 -5 cm in diameter. However, it was also reported in some cases that

IFPs size increase upto 12.5cm in diameter in some cases [8]. IFP was first come in discussion by

Vanek in 1949 as a 'gastric submucosal granuloma with eosinophilic infiltration [9].

IFPs are generally idiopathic, usually recognized at the time of endoscopy or laparotomy. When

IFPs give no sign and symptoms they are evaluated by anatomic site [8, 10]. When IFPs

originate from small bowel, the most common clinical finding is intussusception [11, 12]. Two

major factors affect the surgical management of intussusception in adult patients i.e. the presence

of malignancy, the edema, and ischemia of effected bowel. Either a wedge resection is done on

involved bowel segment which may be unsafe or polyps can be removed locally by limited

enterotomy. The healthy bowel margins must be protected at the time of segmental resection.

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