A Case Report of a Primary Intususseption in Pregnancy

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

¹Department of Obstetrics and Gynecology, Thompson General Hospital, Northern Regional Health authority, Thompson, Manitoba, Canada

Cite this paper:
Arjowan Mustafa, Lina Azzam and Hussam M. Azzam. A Case Report of a Primary Intususseption in Pregnancy. American Journal of Medical Case Reports. 2016; 4(11):357-360. doi: 10.12691/ajmcr-4-11-2

Abstract

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].

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

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]	Intussusception in Pregnancy- A rarely Considered Diagnosis Osime OC, Onakewhor J and Irowa OO African Journal of Reproductive Health March 2010; 14(1): 145.
[2]	Intussusception in Pregnancy: A Rare Case Report K Smitha Sreenivas , S Vinayachandran IJSS Case Reports & Reviews July 2014, Volume 1, Issue 2.
[3]	Primary Jejunal intussusception in pregnancy: a rare case report Ozyapi et al. Journal of Turkish-German Gynecological Association 2009; 10: 120-1.
[4]	Adult Intussusception: a report of 5 cases Pritchard A, McDermott EW, Hill ADK, Murphy JJ, O’ Higgins NJ. Ir J Med Sci. 170(1): 71-72.
[5]	Intussusception in Adults: An unusual and challenging condition for surgeons Erkan N, Haciyanli M, Yildirim M, Sayhan H, Vardar E, Polat F. Intl J colorectal Dis 2005; 20: 452-6.
[6]	A case of intussusception managed conservatively in pregnancy Hyo-Jeong Kang, Seo-Hee Kim, Ju-Hyun Ryu, Suk-Joo Choi and Cheong-Rae Roh Journal of Women’s Medicine 2011;4(1):15-18.
[7]	Adult Intussusception: Experience in Singapore Tan KY, Tan SM, Tan AG, Chen CY, Chng HS, Hoe MN ANZ J Surg 2003; 73: 1044-7.
[8]	Intussusception: a rare cause of abdominal pain in pregnancy D.Penney, R.Ganpathy, M. Jonas-Obichere, H. El-Refeay Ultrasound in Obstetrics & Gynecology 2006, volume 28, issue 5, pages 723-725.
[9]	Heterotopic pancreas as a leading point for small bowel intussusception in a pregnant woman Gurbulak B, Kabul E, Dural C, Citaleak G, Yanar H, Gulluoglu M, Tavilogulu K J Pancreas (online) 2007; 8(5): 584-587.
[10]	Preoperative Diagnosis of intestinal intussusception in pregnancy: a case report Shenhav S, Gemer O, Segal S, Linova L, Joffe B J Reprod Med 2000; 45:501-3.
[11]	Intestinal obstruction complicating pregnancy Perdue Pw, Johnson HW, Stafford PW Am J Surg 1992; 164: 384-8.
[12]	Adult intussusception Azar T, Berger DL Annals of Surg 1997; 226: 134-8.
[13]	Adult intussusception detected at CT or MRI imaging: clinical imaging correlation Warshauer DM, Lee JK Radiology 1999; 212: 853-60.
[14]	Intussusception During Pregnancy: A case Report and Review of the Literature P.Mahungu, F. Galerneau, D. Pugash and K. Williams Journal SOGC, January 1996.
[15]	Adult Intussusception- a surgical dilemma Rathore MA, Andrabi SIH, Mansha M J Ayub Med Coll Abbotabad 2006; 18(3): 3-6.
[16]	Clinical spectrum and surgical approach of adult intussusception: a multicentric study Barussaud M et al Int J Colorectal Dis. 2006; 21(8): 834-839.
[17]	Intussusception in adults: institutional review Eisen LK, Cunningham JD, Aufses AH Jr J Am Coll Surg 1999; 188: 390-395.
[18]	The diagnosis and management of adult intussusceptions Begos DG, Sandor A, Modlin IM Am J Surg 1997; 173: 88-94.
[19]	Intussusception caused by a carcinoma of the cecum during pregnancy, report of a case and review of literature Shioda Y et al Surg Today 1993; 23(6):556-561.
[20]	Primary Intussusception in Pregnancy: A Case report Gould CH, Maybee GJ, Leininger B and Winter WE 3rd J Rep Med, 2008 September; 53(9):703-7.
[21]	Small intestinal obstruction in pregnancy and puerperium Chiedozi LC, Ajabor L, Iweze F Saudi J Gastroenterol 1999;5: 134-9.
[22]	Guidelines for Diagnostic Imaging During Pregnancy and Lactation ACOG Committee Opinion, Number 656 February 2016.
[23]	ACR Practice Guideline for Imaging Pregnant or potentially Pregnant Adolescents and Women with Ionizing Radiation 2008: 1-15. Wagner L, Applegate K.
[24]	National council on radiation Protection and measurements. Medical Radiation Exposure of Pregnant and Potentially Pregnant Women. NCRP report no. 54. Betheseda, Md. National Council on Radiation Protection and Measurements, 1977.
[25]	Guidelines for computed tomography and magnetic resonance imaging during pregnancy and lactation. Chen MM, Coakley FV, Kiamal A. Laros RK Jr. Obstet Gynecol 2008; 112: 333-40.
[26]	Idiopathic Postpartum Intussusception: A Rare cause of Acute Abdominal Pain Ercan Kocakoc, Zulkif Bozgeyik, Mustafa Koc and Mehtab Balaban Medical Principles Practice 2010; 19: 163-165.