Baylor University Medical Center Proceedings April 2014, Volume 27, Number 2 | Page 54

Small bowel intussusception causing a postoperative bowel
obstruction following laparoscopic low anterior resection in
an adult
Ahmad S. Hussain, MD, Rajalakshmi Warrier, MD, and Harry T. Papaconstantinou, MD

Adult intussusception usually presents with nonspecific symptoms
such as abdominal pain, bloating, nausea, vomiting, and a change
in bowel habits. Although postoperative intussusception has been
described in the pediatric population, there has been little description of it in the adult population. Postoperative intussusception has
unique challenges, as hydrostatic reduction may compromise bowel
anastomoses. Surgery is the universal treatment in these patients.
In adults, delay in diagnosis and definitive treatment may be a direct
result of common symptomatology between postoperative ileus and
intussusception. We present a case of an adult patient who underwent
laparoscopic low anterior resection for rectal cancer and developed a
small bowel intussusception causing obstruction requiring surgery. To
our knowledge, this is the first report of a small bowel intussusception masquerading as a postoperative ileus in an adult. While most
postoperative delayed bowel function is attributed to ileus, abscess
formation, or anastomotic leak, other uncommon etiologies, including intussusception, may occur and are important to include in the
differential diagnosis.

ntestinal intussusception is a relatively common abdominal
emergency in children; however, the incidence of intussusception in adults is rare and represents less than 5%
of all cases (1). In adults, transient asymptomatic enteric
intussusception is often noted on imaging and resolves spontaneously without any treatment (2). Complete and persistent
small bowel obstruction secondary to intussusception is less
common and is usually associated with a lead point lesion
(1). Adult intussusception usually presents with nonspecific
symptoms such as abdominal pain, bloating, nausea, vomiting, and a change in bowel habits. The abdominal exam is
often unremarkable, which contributes to an error or delay
in diagnosis. In children, initial attempts at reduction of the
intussusception with barium or air are often suggested, but
in adults surgery is the definitive treatment (3). Postoperative
intussusception has unique challenges, as hydrostatic reduction may compromise bowel anastomoses (4). In adults, delay
in diagnosis and definitive treatment may be a direct result
of common symptomatology between postoperative ileus
and intussusception. We present a case of an adult patient

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who underwent laparoscopic low anterior resection for rectal
cancer and developed a small bowel intussusception causing
obstruction.
CASE REPORT
A 75-year-old man with chronic obstructive pulmonary
disease with bronchiectasis, coronary artery disease, and
hypertension underwent a single-incision laparoscopic low
anterior resection for recurrent rectal cancer. Nonsteroidal
antiinflammatory drugs were not utilized for pain control.
Postoperatively, he had persistent abdominal bloating, nausea, and emesis. Examination revealed a hypertympanic distended abdomen without signs of peritonitis. A computed
tomography (CT) scan of the abdomen and pelvis disclosed
a significantly dilated colon and small bowel with no signs of
obstruction. The bowel gas pattern was consistent with a postoperative ileus. The patient was initiated on total parenteral
nutrition. His condition thereafter progressively improved
with reduced abdominal distention. His bowel function eventually returned, an enteral diet was advanced as tolerated, and
he was sent home on postoperative day 20 on a regular diet.
Two days after discharge, the patient returned to the hospital
with obstipation, mild abdominal bloating, and emesis. CT
scan demonstrated an ileoileal intussusception causing a highgrade small bowel obstruction (Figure 1).
Nasogastric tube decompression and intravenous fluids
were initiated, and the patient continued to have signs of
bowel obstruction. At operation, he was found to have a
small bowel intussusception with fibrous bands holding
the telescoped bowel in place (Figure 2). He underwent
a small bowel resection and primary anastomosis without

From the Department of Surgery (Hussain, Warrier, Papaconstantinou), Section of
Colon and Rectal Surgery (Warrier), Scott & White Memorial Hospital and Clinic
and Texas A&M University System Health Science Center College of Medicine,
Temple, TX.
Corresponding author: Harry T. Papaconstantinou, MD, Associate Professor and
Interim Chairman, Department of Surgery, Scott & White Memorial Hospital and
Clinic, 2401 South 31st Street, Temple, TX 76508 (e-mail: hpapaconstantinou@
sw.org).

Proc (Bayl Univ Med Cent) 2014;27(2):128–130