P Matheiowetz1, J Voigt, G Faller, E Siegel. 1. Medizinische Klinik 1 (Gastroenterologie, Endokrinologie und Diabetologie), St. Vincentius-Kliniken gAG, Karlsruhe. peter.matheiowetz@vincentius-ka.de
Abstract
HISTORY AND ADMISSION FINDINGS: A 38-year-old woman (Pt. 1) and a 30-year-old man (Pt. 2) had been admitted, over a period of two months to the emergency unit. Pt 1. had complained of spasmodic pain with nausea and vomiting. A mass was palpated in the left upper abdominal quadrant. Pt. 2 had signs suggesting appendicitis, with pain in the right lower abdominal quadrant. INVESTIGATIONS: Abdominal ultrasound showed an intussusception with a typical multilayered bowel wall ("target-like" or "bull's eye") sign in both patients. The man also had a normally appearing appendix and enlarged mesenteric lymph nodes. TREATMENT, COURSE AND DIAGNOSIS: Pt. 1 had a laparotomy, which showed a leiomyoma of the small bowel. After resection the further course was uneventful. The intussusception of the 30-year-old man resolved spontaneously during the ultrasound examination. Further investigation revealed celiac disease. CONCLUSIONS: Intussusception is a possible cause of acute abdominal pain in adults. Ultrasonography should be the initial diagnostic investigation. Transient intussusceptions are seen in adults with celiac disease, in which case nonoperative treatment is possible. Copyright Georg Thieme Verlag KG Stuttgart . New York
HISTORY AND ADMISSION FINDINGS: A 38-year-old woman (Pt. 1) and a 30-year-old man (Pt. 2) had been admitted, over a period of two months to the emergency unit. Pt 1. had complained of spasmodic pain with nausea and vomiting. A mass was palpated in the left upper abdominal quadrant. Pt. 2 had signs suggesting appendicitis, with pain in the right lower abdominal quadrant. INVESTIGATIONS: Abdominal ultrasound showed an intussusception with a typical multilayered bowel wall ("target-like" or "bull's eye") sign in both patients. The man also had a normally appearing appendix and enlarged mesenteric lymph nodes. TREATMENT, COURSE AND DIAGNOSIS: Pt. 1 had a laparotomy, which showed a leiomyoma of the small bowel. After resection the further course was uneventful. The intussusception of the 30-year-old man resolved spontaneously during the ultrasound examination. Further investigation revealed celiac disease. CONCLUSIONS: Intussusception is a possible cause of acute abdominal pain in adults. Ultrasonography should be the initial diagnostic investigation. Transient intussusceptions are seen in adults with celiac disease, in which case nonoperative treatment is possible. Copyright Georg Thieme Verlag KG Stuttgart . New York