Arjowan Mustafa^1,, Lina Azzam¹, Hussam M. Azzam¹

Intussusception is defined as invagination of one part of the bowel into another which leads to intestinal obstruction and compromise the mesenteric blood flow with resultant inflammation and the potential for ischemia [1,2]. This condition is very rare condition in pregnancy and very difficult to diagnose due to its rarity and because of the anatomical changes of pregnancy which leads to displacement of the bowel by the gravid uterus which hamper adequate abdominal assessment as well it’s vague symptoms [3]. Usually the disease is common in pediatric age but rare in adults as 95% of cases occur in children and only 5% seen in adults [4]. Adult age intussusception is usually secondary to a lesion which is called a lead point which is present in 90% of adult intussusception and it is rare to find a primary type of intussusception (i.e. with no lead point) [4,5]. In this report we present a case of a 23 years old woman who presented at 26 weeks of her first pregnancy with vague upper abdominal pain with nausea and emesis which was thought to be either gastritis or cholecystitis. She was treated with intravenous (IV) fluid hydration and analgesics with no improvement. The patient’s clinical condition deteriorated after 3 days and re assessment showed that the abdomen was distended with absent bowel sounds and generalized tenderness with her vomiting getting worse and associated with constipation. A plain abdominal x ray showed features suggestive of intestinal obstruction which failed to improve on conservative management and the patient was counseled about doing a CT (computed tomography) to confirm the diagnosis because the safer alternative which is the MRI (Magnetic resonance imaging) was not available in our hospital. After confirmation, the patient underwent a laparotomy and was found to have a jujenal intussusception with no lead point, bowel resection with end to end anastomosis was done and the patient had a good postoperative recovery. We recommend that a high index of suspicion is necessary by the obstetricians and surgeon when they deal with a pregnant woman with vague abdominal pain which fails to respond to usual conservative measures so they will not miss such a rare condition in pregnancy which can be associated with high risk of fetal and maternal morbidity and even mortality if the timely diagnosis and treatment was delayed [6,7,8].

Intussusception, intestinal obstruction, MRI (Magnetic resonance imaging), CT Scan (Computerized Tomography Scanning), pregnancy