Intussusception is telescoping of one segment of the intestine into the immediately distal segment of the bowel. Approximately 5% of all cases of intussusception occur in adults1. Since adult intussusception does not show typical clinical features such as acute onset, episodic abdominal pain and current jelly stools that are frequently noted in pediatric intussusception, its diagnosis is usually delayed2. In contrast to pediatric intussusception, underlying lesions are identified in 70% to 90% of patients with adult intussusception and malignant neoplasia in 40% of patients3.We report herein a case of adult ileoileal intussusception which was induced by a lipoma with a brief review of the literature. Case report A 73-year-old woman with a 3- to 4-month history of periumbilical discomfort was transferred from a regional hospital due to severe generalized abdominal pain and vomiting which occurred 8 hours prior to this presentation. There was no remarkable medical or family history. Her history revealed no chill, fever, generalized weakness, weight loss, chest pain or dyspnea. Abdominal pain persisted around the umbilicus without radiation and was not aggravated by changes in position. Vomiting occurred 3 to 4 times a day, but diarrhea, melena or hematochezia did not occur. Three hours prior to this presentation, she had normal defecation. She had no hematuria, frequency, dysuria or residual urine sense.Her vital signs were as follows: blood pressure, 150/90 mmHg; pulse rate, 84 beats/min; respiratory rate, 20 beats/min; and body temperature, 36.5oC. On physical examination, she showed pale conjunctiva, clean breath sounds and normal heart sounds, but did not show wheezing, rales or murmur. Her abdomen was mildly distended, and bowel sounds were decreased. Abdominal palpation showed minimal tenderness on periumbilical area and left upper abdomen. A 10-cm mobile mass was palpable at the site of maximal tenderness. There was no rebound tenderness. Digital rectal examination revealed neither melena, hematochezia, nor mass. Percussion of the costovertebral area showed no tenderness.Blood tests revealed: WBC, 12,850/mm 3 (neutrophil, 90.1%); hemoglobin, 10.4 g/dl; platelet, 311,000/mm 3 ; BUN/Cr, 10/0.9 mg/dl; AST/ALT, 28/23 IU/L; amylase, 44 IU/L; total bilirubin/direct hilirubin, 0.5/0.1 mg/dl; total protein/albumin, 6.7/3.6 gldl; alkaline phosphatase (ALP) 45 IU/L; and PT/aPTT, 10.7/27.0 sec. Arterial blood gas analysis showed: pH, 7.426; pCO2, 33.8 mmHg; P02, 66.3 mmHg; HCO3, 23.0 mmol/L; base excess, -1.9 mmol/L; and Sa02, 92.5%. Plain radiographs of the abdomen exhibited findings of small bowel ileus and an air-fluid level suggestive of intestinal obstruction. Computed tomography (CT) of the abdomen was performed in order to rule out colon cancer, intestinal obstruction, diverticulitis and omental infarction. CT scan of the abdomen revealed an ileoileal intussusception without any evidence of bowel strangulation but with a low-density mass suggestive of a lipoma (Figure 1). Emergency operation was performed for radical treatment. At surgery, the 110-cm ileum was telescoped into the approximately 170-cm proximal segment. A 4x4-cm hard mass was manually dissected from its originating site, and the ileum was transected proximally and distally 5 cm beyond the mass, encompassing the mass after the viability of the ileum was confirmed to be intact. Histopathological examination of the surgical specimen revealed a lipoma of the ileum. After surgery, she improved and there were no significant complications such as wound infection.
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机译：肠套叠是将肠的一部分伸缩到肠的紧邻远端部分。在所有肠套叠病例中，约有5％发生在成年人中1。由于成人肠套叠没有表现出典型的临床特征，例如急性肠套叠，发作性腹痛和小儿肠套叠中经常出现的果冻样，因此其诊断通常会延迟2。与小儿肠套叠相反，在成人肠套叠的70％至90％的患者中发现了潜在的病变，在40％的患者中发现了恶性肿瘤3。文献。病例报告一名73岁的妇女，有3至4个月的脐周不适史，由于严重的全身性腹痛和呕吐而从一家地方医院转移过来，而腹痛和呕吐发生在就诊前8小时。没有明显的病史或家族史。她的病史没有发冷，发烧，全身无力，体重减轻，胸痛或呼吸困难。腹部疼痛持续存在于脐带周围，没有放射线，并且不会因姿势变化而加剧。每天呕吐3至4次，但未出现腹泻，黑便或便血。演讲前三个小时，她的排便正常。她没有血尿，尿频，尿痛或残留尿感。她的生命体征如下：血压为150/90 mmHg;血压为150/90 mmHg。脉搏频率为84次/分钟呼吸频率，20次/分钟;和体温36.5oC。体格检查时，她的结膜苍白，呼吸音和心音正常，但没有喘息，罗音或杂音。腹部轻微扩张，肠鸣音减弱。腹部触诊显示在脐周区域和左上腹部的压痛最小。在最大压痛部位可触及10厘米的活动块。没有反弹压痛。直肠指检未发现黑斑病，便血或肿块。触诊肋椎区无压痛。血液测试显示：白细胞为12,850 / mm 3（中性粒细胞为90.1％）。血红蛋白10.4 g / dl;血小板，311,000 / mm 3; BUN / Cr，10 / 0.9 mg / dl; AST / ALT，28/23 IU / L;淀粉酶，44 IU / L;总胆红素/直接胆红素，0.5 / 0.1 mg / dl;总蛋白/白蛋白6.7 / 3.6 gldl;碱性磷酸酶（ALP）45 IU / L;和PT / aPTT，10.7 / 27.0秒。动脉血气分析表明：pH为7.426; pCO2，33.8毫米汞柱; P02，66.3毫米汞柱;碳酸氢盐，23.0 mmol / L;碱过量-1.9 mmol / L; Sa02为92.5％。腹部X线平片表现出小肠肠梗阻和提示肠梗阻的气液水平。为了排除结肠癌，肠梗阻，憩室炎和网膜梗塞，进行了腹部CT（CT）检查。腹部CT扫描显示回肠套叠，无肠绞窄迹象，但低密度肿块提示有脂肪瘤（图1）。紧急手术进行了根治。手术时，将110厘米的回肠套入约170厘米的近端节段。从其起源部位手动解剖4x4-cm的硬块，并且在确认回肠的生存力是完整的之后，将回肠向近侧和远侧横越该块5cm，包括该块。手术标本的组织病理学检查显示回肠有脂肪瘤。手术后，她康复了，没有明显的并发症，例如伤口感染。
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