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).