University of California, Irvine, Department of Emergency Medicine, Irvine, CA.
West J Emerg Med. 2010 May;11(2):197-200.
Intussusception is a condition found primarily in the pediatric population. In the adult population, however, intussusception is usually due to a pathological process, with a higher risk of bowel obstruction, vascular compromise, inflammatory changes, ischemia, and necrosis. Radiographic and sonographic evidence can aid in the diagnosis. Surgical intervention involving resection of affected bowel is the standard of care in adult cases of intussusception.
We present the case of a 21-year-old female who presented to the Emergency Department with diffuse cramping abdominal pain and distention. Workup revealed ileocecal intussusception, with a prior appendectomy scar serving as the lead point discovered during exploratory laparotomy. We also present the case of a 66-year-old male, who presented with one week of intermittent lower abdominal pain associated with several episodes of nausea and vomiting. Workup revealed ileocolic intussusception secondary to adenocarcinoma of the right colon, confirmed upon exploratory laparotomy with subsequent right hemicolectomy.
In the adult population, intussusception is usually caused by a lead point, with subsequent telescoping of one part of the bowel into an adjacent segment. While intussusception can occur in any part of the bowel, it usually occurs between a freely moving segment and either a retroperitoneal or an adhesion-fixed segment. The etiology may be associated with pathological processes such as carcinoma or iatrogenic causes, such as scars or adhesions from prior surgeries. The cases presented here demonstrate important etiologies of abdominal pain in adult patients. Along with gynecological etiologies of lower quadrant abdominal pain in female patients, it is important for the emergency physician to expand the differential diagnosis to include other causes, such as intussusceptions, especially given the symptoms that could be associated with bowel obstruction.
肠套叠主要发生在儿科人群中。然而，在成人中，肠套叠通常是由病理过程引起的，伴有更高的肠梗阻、血管损伤、炎症变化、缺血和坏死风险。放射学和超声证据有助于诊断。涉及切除受累肠段的手术干预是成人肠套叠病例的标准治疗方法。
我们报告了两例病例。一例是 21 岁女性，因弥漫性痉挛性腹痛和腹胀就诊于急诊科。检查发现回盲肠套叠，探查性剖腹手术中发现先前阑尾切除术的疤痕作为套叠的起点。我们还报告了一例 66 岁男性，因间歇性下腹疼痛伴数周恶心和呕吐就诊。检查发现回结肠套叠，继发于右结肠癌，经探查性剖腹手术证实，随后行右半结肠切除术。
在成人中，肠套叠通常由一个套叠点引起，随后一段肠管套入相邻段。虽然肠套叠可发生在肠的任何部位，但通常发生在自由移动段与腹膜后或粘连固定段之间。病因可能与癌或医源性原因（如先前手术的疤痕或粘连）相关。这里报告的病例说明了成人腹痛的重要病因。除了女性患者下腹部疼痛的妇科病因外，对于急诊医生来说，重要的是将鉴别诊断扩展到包括其他病因，如肠套叠，特别是因为可能与肠梗阻相关的症状。
