Intussusception Presenting as Intestinal Obstruction in Pregnancy: A Case Report from a Tertiary Hospital in Ghana

Anwar Sadat Seidu^1, , David Putiero Suoseg², Mohammed Sheriff¹, Musah Yakubu¹, Emmanuel Agoswin Noah Azure¹ and Edmund Muonir Der³

¹Department of Surgery, Tamale Teaching Hospital, Box TL 16, Tamale, Ghana

²Department of Obstetrics and Gynecology, Tamale Teaching Hospital, Box TL 16, Tamale, Ghana

³Department of Pathology; School of Medicine and Health Sciences, University for Development Studies and Tamale Teaching Hospital, Box TL 1350, Tamale, Ghana

Cite this paper

Anwar Sadat Seidu, David Putiero Suoseg, Mohammed Sheriff, Musah Yakubu, Emmanuel Agoswin Noah Azure and Edmund Muonir Der. Intussusception Presenting as Intestinal Obstruction in Pregnancy: A Case Report from a Tertiary Hospital in Ghana. American Journal of Medical Case Reports. 2020; 8(12):459-462. doi: 10.12691/AJMCR-8-12-7

Abstract

There is paucity of scientific data on intussusception in pregnancy globally which makes it a rare clinical occurrence. The symptoms in pregnancy may mimic obstetric conditions and thus presents a diagnostic dilemma to clinicians. A high index of suspicion is therefore needed in order to establish a preoperative diagnosis. We present a 29-year old woman, gravida 5 para 4, 2 alive and 2 dead (G5P4^2A+2D) at 23-weeks’ 6 days gestation from northern Ghana, who was referred to Tamale Teaching Hospital (TTH) as a case of acute abdomen. Initial clinical assessment and bedside ultrasonography led to a diagnosis of intussusception. A viable colo-colic intussusception was found on open laparotomy and a left hemicolectomy was performed. This was confirmed by histopathological examination of the resected bowel. There was no identifiable lead point. This case report illustrates how good and prompt initial clinical assessment supported with imaging led to a successful outcome of acute abdomen in pregnancy in a low – middle resource country.

Keywords

intussusception, pregnancy, intestinal, obstruction, Ghana

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]	Singhal S, Singhal A, Arora PK, Tugnait R, Tiwari B, Malik P, et al. Adult Ileo-Ileo-Caecal Intussusception: Case Report and Literature Review [Internet]. Vol. 2012, Case Reports in Surgery. Hindawi; 2012 [cited 2020 May 24]. p. e789378. Available from: https://www.hindawi.com/journals/cris/2012/789378/.
[2]	Das A, Ralte L, Chawla AS, Arya SV, Kumar A, Saroha R, et al. Colocolic Intussusception in an Older Child: A Rare Case Report and a Literature Review [Internet]. Vol. 2013, Case Reports in Surgery. Hindawi; 2013 [cited 2020 May 24]. p. e106831. Available from: https://www.hindawi.com/journals/cris/2013/106831/.
[3]	Shenoy k. R, Shenoy A. Buy MANIPAL MANUAL OF SURGERY 5ED (PB 2020) Book Online at Low Prices in India | MANIPAL MANUAL OF SURGERY 5ED (PB 2020) Reviews & Ratings - Amazon.in [Internet]. [cited 2020 May 29]. Available from: https://www.amazon.in/MANIPAL-MANUAL-SURGERY-5ED-2020/dp/9389261791.
[4]	Adiotomre P, Asumang E, Godbole P. Intussusception in a 7-week-old baby. BMJ Case Rep [Internet]. 2013 May 15 [cited 2020 May 24]; 2013. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3669823/.
[5]	Brill A, Lopez R. Intussusception In Adults. StatPearls [Internet]. 2020 May 4 [cited 2020 May 24]; Available from: https://www.statpearls.com/kb/viewarticle/23742.
[6]	D L, S S. Missed case of intussusception, a rare cause of abdominal pain in adults: A case report emphasizing the imaging findings and review of the literature. Radiol Case Rep. 2019 May 24; 14(8): 906-10.
[7]	Tan KY, Tan S-M, Tan AGS, Chen CYY, Chng H-C, Hoe MNY. Adult intussusception: experience in Singapore. ANZ J Surg. 2003 Dec; 73(12): 1044-7.
[8]	Intussusception: a rare cause of abdominal pain in pregnancy - Penney - 2006 - Ultrasound in Obstetrics & Gynecology - Wiley Online Library [Internet]. [cited 2020 May 24]. Available from: https://obgyn.onlinelibrary.wiley.com/doi/full/10.1002/uog.3810.
[9]	Prichard R, McDermott E, Hill A, Murphy J, O’Higgins N. Adult intussusception: A report of five cases. Irish journal of medical science. 2001 Jan 1; 170: 71-2.
[10]	Erkan N, Haciyanli M, Yildirim M, Sayhan H, Vardar E, Polat AF. Intussusception in adults: an unusual and challenging condition for surgeons. Int J Colorectal Dis. 2005 Sep; 20(5): 452-6.
[11]	Mustafa A, Azzam L, Azzam HM. A Case Report of a Primary Intususseption in Pregnancy. American Journal of Medical Case Reports. 2016 Dec 7; 4(11): 357-60.
[12]	S LM, Abraham R, Chitra TV. Intestinal obstruction in pregnancy: three case reports. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2016 Dec 10; 2(3): 491-3.
[13]	Mahungu P, Galerneau F, Pugash D, Williams K. Intussusception During Pregnancy: A Case Report and Review of the Literature. Journal SOGC. 1996 Jan; 18(1): 77-80.
[14]	Luhmann A, Tait R, Hassn A. Intussusception in a 20 weeks pregnant woman: a case report. Cases J [Internet]. 2009 Aug 5 [cited 2020 May 24]; 2. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769300/.
[15]	Gould CH, Maybee GJ, Leininger B, Winter WE. Primary intussusception in pregnancy: a case report. J Reprod Med. 2008 Sep; 53(9): 703-7.
[16]	Achour R, Harabi S, Neji K. Spontaneous acute intussusception in a pregnant woman. Case Reports in Women’s Health. 2017 Jan 1; 13: 6-8.
[17]	Nagorney DM, Sarr MG, McIlrath DC. Surgical management of intussusception in the adult. Ann Surg. 1981 Feb; 193(2): 230-6.
[18]	Weledji EP, Simo AW. Idiopathic Post-Partum Intussusception: A Case Report. 2019; 4: 2.
[19]	Belhamidi MS, Aitali A, Tarchouli M, Baba H, Bounaim A, Sair K. Ileo-ileal intussusception in adult caused by Vanek’s tumor: a report of five cases. International Surgery Journal. 2016 Dec 14; 2(4): 595-8.
[20]	Al-Saad S, Al-Helo H. Ileocolic Intestinal Intussusception in Adults: A Case Report. :4.
[21]	Yalamarthi S, Smith R. Adult intussusception: case reports and review of literature. Postgrad Med J. 2005 Mar; 81(953): 174-7.
[22]	Medina CAC. Clinical case presentation: Diagnosis and treatment of idiopathic intussusception in adults. 5.
[23]	Iyassu S, Abraha M. Case Report: Rare presentation of adult intussusception at Orotta National Referral Hospital, Eritrea. F1000Res. 2019 Jan 14; 8: 55.
[24]	Bousseaden A, Afifi R, Essamri W, Benelbarhdadi I, Ajana FZ, Benazzouz M, et al. Adult colocolic intussusception diagnosed by ultrasonography: a case report. Journal of Medical Case Reports. 2011 Jul 7; 5(1): 294.
[25]	Shenhav S, Gemer O, Segal S, Linova L, Joffe B. Preoperative diagnosis of intestinal intussusception in pregnancy. A case report. J Reprod Med. 2000 Jun; 45(6): 501-3.
[26]	Uyulmaz S, Zünd M, Caspar U, Diebold J, Slankamenac K. Ileoileal intussusception in unspecific recurrent abdominal pain in adult: A case report. SAGE Open Medical Case Reports. 2018 Jan 1; 6: 2050313X18792814.
[27]	Aberra Y. A Case Report on Post-Operative Intussusceptions in Adult. Journal of Gastrointestinal & Digestive System. 2018 Apr 3; 8(2): 1-4.
[28]	Hadid T, Elazzamy H, Kafri Z. Bowel Intussusception in Adults: Think Cancer! CRG. 2020; 14(1): 27-33.
[29]	Li Z, Sun M, Song B, Shu Z. Gastrointestinal hemorrhage caused by adult intussusception secondary to small intestinal tumors: Two case reports. Medicine. 2018 Aug; 97(34): e12053.
[30]	Perdue PW, Johnson HW, Stafford PW. Intestinal obstruction complicating pregnancy. Am J Surg. 1992 Oct; 164(4): 384-8.
[31]	Mustafa A, Azzam L, Azzam HM. A Case Report of a Primary Intususseption in Pregnancy. American Journal of Medical Case Reports. 2016 Dec 7; 4(11): 357-60.
[32]	Ramsey KW, Halm BM. Diagnosis of Intussusception Using Bedside Ultrasound by a Pediatric Resident in the Emergency Department. Hawaii J Med Public Health. 2014 Feb; 73(2): 58-60.
[33]	Riera A, Hsiao AL, Langhan ML, Goodman TR, Chen L. Diagnosis of intussusception by physician novice sonographers in the emergency department. Ann Emerg Med. 2012 Sep; 60(3): 264-8.