Non-Operative Management of Incidental IntussuseptionAfter Blunt Trauma

Mark A. Jones, M.D., Stephen A. Fann, M.D., Raymond P. Bynoe, M.D.

University of South Carolina Department of Surgery and Palmetto Health

BACKGROUND

Intussusception after abdominal trauma is exceedingly uncommon and is rarely reported in the literature. There are no reports in the literature of incidental intussusception identified on abdominal computed tomography (CT) in an asymptomatic patient following blunt trauma. This scenario demonstrates an interesting management dilemma that will be encountered more often as the use of CT in the evaluation of trauma patients grows.

CASE REPORT•21 year old male•Status post motor vehicle crash•Worked up by emergency department including: CT scans of head, C-spine, chest, abdomen, and pelvis•Jejuno-jenjunal intussusception on abdominal CT•Asymptomatic

METHODS

RESULTS

REFERENCES

•Asymptomatic in follow-up•No evidence of intussusception on repeat CT abdomen•No evidence of intussusception or lead point on upper GI series•Discharged from surgical care and follow-up

DISCUSSION

No previous reported case of incidental intussusception after blunt trauma was found in the literature. Historically it has been thought that intussusception in an adult mandates an operation due to the high percentage of associated pathologies. We feel that traumatic intussusception should not fall into the same algorithm. This case demonstrates that traumatic intussusception in an asymptomatic patient can be managed non-operatively with close observation. Follow-up radiographs help to show resolution of the intussusception and to establish that there is no underlying pathology responsible for it. As CT continues to become the screening tool of choice in trauma centers, we can expect to find more and more incidental abnormalities for which a treatment plan must be designed.

1. Chong T, Victorino G. CT diagnosis of postoperative intussusception after penetrating abdominal trauma. J Gas Sur 2003;12:387-388.2. Berne JD, Asenio JA, Gomez H, Chahwan S, Falabella A. Double intussusception in an adult following laparotomy for trauma: a case

report and review of the literature. Am Surg. 1998;64:781-784.3. Hengster P, Pernthaler H. Enteric intussusception after a road traffic accident in a 19 year old girl. Eur J Surg. 1993;159:311-312.4. Bashir MO, Lynch G. Post traumatic intussusception in an adult. Ir J Med Sci. 1993;162:20.5. Duncan A, Phillips TF, Sclafani SJ et al. Intussusception following abdominal trauma. J Trauma. 1987;27:1193-1199.6. Stockinger AT, McSwain N. Intussusception caused by abdominal trauma: a case report and review of 91 cases reported in the literature. J

Trauma. 2005;58:187-1887. Brooks A, Bebington BD, Lucas S, Oettle GJ. Intussusception caused by blunt abdominal trauma. J Trauma. 1999;47:157-157.8. Casingal VP, Jacobs DG. Intussusception after damage-control laparotomy: a case report. J Trauma. 2004;56:924-925.9. Saxena AK, Sodhi KS, Khandelwal S, Rao KLN, Suri S. Blunt abdominal trauma: an unusual cause of intussusception. Pediatr Radiol.

2004;34:364.10. Komadina R, Smrkolj V. Intussusception after blunt abdominal trauma. J Trauma. 1998;45:615-616.

•Observed patient in emergency department with serial abdominal exams•Discharged patient home from emergency department with short-term follow-up as outpatient•Remained asymptomatic on follow-up•Elected to re-assess with repeat CT abdomen and upper GI with small bowel follow-through

Initial CT scan showing intussusception

Follow-up CT scan showingresolution of intussusception

Normal Upper GI series at follow-up