Medical College of Georgia, Augusta University Augusta, GA
Kwabena Asafo-Agyei, MBChB1, John Kirkikis, MD2, Dustin Hadley, PA-C2, Humberto Sifuentes, MD3 1Medical College of Georgia, Augusta University, Augusta, GA; 2GIS, Shreveport, LA; 3Augusta University, Augusta, GA
Introduction: Intussusception involves the folding of the proximal bowel loop into the distal bowel. This condition is uncommon in adults, representing only 5% of all intussusception cases. Duodenal intussusception is also rarely observed, likely due to the duodenum's fixed retroperitoneal position. To our knowledge, only one case of duodenal intussusception has been reported during an Esophagogastroduodenoscopy (EGD).
Case Description/Methods: A 28-year-old African-American male with no medical or surgical history presented with a few days of episodes of black, tarry stools and symptomatic anemia. He denied abdominal pain, nausea, vomiting, coffee-ground emesis, and NSAID abuse. He, however, took one dose of ibuprofen on the day of presentation. The initial hemoglobin was 4.5 g/dl on admission, and 3 units of packed red blood cells were transfused.
EGD done for melena and symptomatic anemia revealed an abnormal appearance of the duodenum. There appeared to be a blind pouch and two openings, and the opening of the rest of the duodenum was very small (Fig 1 and 2). Also, a duodenal ulcer was noted at the beginning of this blind pouch (Fig 3).
Due to his suspected abnormal anatomy, an upper gastrointestinal series was ordered to clarify any anatomical variant. The series showed pronounced dilatation of the duodenal bulb, the proximal second portion of the duodenum, and suspected duodenal intussusception without an apparent lead point (Fig 4). These findings were confirmed on a computed tomography (CT) scan of the abdomen and pelvis with intravenous and oral contrast (Fig 5).
He was subsequently evaluated by general surgery and discharged home safely to follow up with a hepatobiliary surgeon as he had no bowel obstruction.
Discussion:
Duodenal intussusception is extremely rare. As noted in our patient, no lead point lesion is present, which accounts for about 8-20% of all intussusception cases. The clinical presentation of intussusception in adults varies and may include gastrointestinal bleeding and symptoms of bowel obstruction. Prompt intervention is typically necessary to prevent obstruction and bowel ischemia. Endoscopic findings for this condition are very rare, so gastroenterologists must be familiar with them to avoid biopsies or advancing endoscopic scopes, which could lead to perforation during procedures.
Figure: ENDOSCOPIC IMAGES, UPPER GI SERIES, AND CT IMAGES
Disclosures:
Kwabena Asafo-Agyei indicated no relevant financial relationships.
John Kirkikis indicated no relevant financial relationships.
Dustin Hadley indicated no relevant financial relationships.
Humberto Sifuentes indicated no relevant financial relationships.
Kwabena Asafo-Agyei, MBChB1, John Kirkikis, MD2, Dustin Hadley, PA-C2, Humberto Sifuentes, MD3. P5031 - An Unusual Presentation of Duodenal Intussusception Noted During Esophagogastroduodenoscopy, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
