Discussion
Intussusception is rare in adults and retrograde intussusception is even less common with a variety of none specific symptoms including bowel obstruction, constipation, abdominal distention, and more commonly abdominal pain causing the diagnosis to be a challenging endeavor (7, 9, 10). The usual symptoms that patients present with are epigastric pain with discrete intensity and duration, nausea, and vomiting (9). In addition, rare cases present with a triad of abdominal pain, hematochezia, and an abdominal mass (4). Based on our search this is the first reported intussusception presenting itself with upper GI bleeding. Although a marginal ulcer was reported in the endoscopy of the patient, there was no active bleeding that could explain hematemesis in our patient. Although examination and laboratory data don’t specify the diagnosis and ultrasound usually is not helpful in adult cases of intussusception, a CT scan with contrast can be the best modality for such cases showing ”target sign” which is suggestive of intussusception diagnosis (9, 11).
The decision of surgical or conservational management of these cases depends on the patient’s condition and the complications that follow. Some cases have shown a spontaneous reduction of intussusception, however, in other cases bowel blockage, bowel ischemia, and bowel distention have been reported causing necessary and emergency surgical management (9). The challenging choice for the management of such cases can be eased with contrast abdominal CT scans (11). Different surgical management choices have been suggested in the literature for intussusception including intussusception reduction and resection of the damaged bowel with re-establishing anastomosis (12).