A 68-year-old man with a history of
Clostridium difficile colitis presented to the emergency department with recurrent abdominal pain and sudden-onset abdominal distension and vomiting. Physical examination revealed that the abdomen was soft, distended, and tender with hypoactive bowel sounds. A computed tomographic scan of the abdomen and pelvis (
image A and
image B) revealed an obstruction due to intussusception of the ileum into the cecum. The small bowel was diffusely distended. During a surgical procedure to remove the obstruction, an ileocecal intussusception was confirmed and a right hemicolectomy was performed. Histologic findings revealed acute ulcerative and pseudomembranous colitis with massive submucosal edema. The patient had an unremarkable recovery.
Intussusception is a rare cause of bowel obstruction in adults. Most cases are associated with a pathologic lead point, such as a mass, which is often malignant.
1,2 The radiologic diagnosis is established by identifying bowel within bowel that demonstrates mesenteric fat and vessels within the intussuscipiens.
3 Management of ileocecal intussusception requires surgical intervention.