C0665 - Intussusception in an Elderly Patient: A Carcinoid Case Report

Christine Catinis, MD, MS
University of Texas Health, Houston, TX

Introduction: Intussusception occurs when a proximal bowel segment slides into a distal bowel segment, which may cause bowel obstruction and intestinal ischemia.^1,2 Although rarely seen in adults¹, intussusception is important to consider when evaluating a patient with abdominal pain as it can lead to life-threatening complications if undetected. Here, we describe a case of intussusception in an elderly gentleman secondary to a carcinoid tumor in his terminal ileum.

Case Description/Methods: A 65-year-old male, with a history of a large rectal tubulovillous adenoma with focal high-grade dysplasia that required surgical resection 10-years ago, hypertension, and diverticulosis presented with a several month history of relapsing lower abdominal pain associated with nausea. His abdominal exam post-attack was normal with the exception of mild tenderness in the right lower quadrant. An abdominal CT showed a 2.3 cm soft tissue density in the small bowel with transient, non-obstructive intussusception. Colonoscopy revealed a firm, submucosal mass 20 cm into the terminal ileum. A biopsy of the mass revealed that it was a carcinoid tumor and the patient has been scheduled for surgical resection.

Discussion: The majority of intussusception cases in adults involve the small bowel and are secondary to a pathological lead point such as a neoplasm, post-surgical adhesions, anatomical changes, endometriosis, or iatrogenic causes such as placement of a gastrostomy or jejunostomy tube.^1-4 Symptoms can be relatively non-specific, and most patients will describe intermittent crampy abdominal pain, bloating, nausea, and vomiting.^4-6 Given its rarity in the adult population and its non-specific presentation, intussusception can be a challenging diagnosis which is often delayed or missed altogether. Prompt diagnosis may prevent complications such as necrosis, perforation, and sepsis.^1,5

1. Brill, A, & Lopez, RA, Intussusception In Adults. 2022. 2. Guner A et al., Small Bowel Intussusception due to Metastasized Sarcomatoid Carcinoma of the Lung: A Rare Cause of Intestinal Obstruction in Adults. 2012. 3. Eisen, LK et al., Intussusception in adults: institutional review. 1999; 390–395. 4. Yalamarthi S, Smith RC. Adult intussusception: case reports and review of literature. 2005; 174-177. 5. Wang LT et al., Clinical entity and treatment strategies for adult intussusceptions: 20 years' experience. 2007; 1941-1949. 6. Marinis A et al., Intussusception of the bowel in adults: a review. 2009; 407-411.



Disclosures:


Christine Catinis, MD, MS. C0665 - Intussusception in an Elderly Patient: A Carcinoid Case Report, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.