Intussusception of the appendix and ileum endometriosis: a case report

Abstract

Introduction: Intussusception is defined as an invagination of one part of the intestine into another section of the bowel. Case report: A 67-year-old woman presented to the ambulatory with pain in the lower right side of the abdomen and nausea lasting for 3 days. Past medical history revealed right ovariectomy because of a cyst. Physical examination revealed an abdominal tenderness in the lower right side of the abdomen. An abdominal ultrasound demonstrated a suspected small bowel intussusception into the cecum of about 2 cm. Radiographic bowel examination with a barium meal test was done, contrast material filled all large bowels. Colonoscopy has shown an edematous Bauhin's valve with small bruising, a biopsy was taken. Histopathological examination of the biopsy material has shown an active ulcerative colitis without tumorous changes. A computed tomography demonstrated small bowel intussusception into the cecumand a contrast filling defect 1.4 × 1.5 cm in the lumen of a terminal ileum. Lower laparotomy was performed. During the exploration there was no visible appendix in the right iliac fossa, but it was palpated in the cecum. In the terminal ileum, a soft subserosal tumor of about 2 cm in size was seen approximately 10 cm from the ileocecal junction. Ileocecal segment resection was performed. Histopathological postoperative examination has shown an intussusception of the appendix with chronic active ulcerative inflammation, hyperplastic/regenerative mucous membrane lesions, and low-grade intraepithelial neoplasia. Small bowel endometriosis was found.Conclusions: Intussusception of the appendix is a very rare condition with an incidence rate of 0.01% in a large surgical material study. It may clinically mimic acute/chronic abdominal diseases or can be asymptomatic. It is important to know about such a rare condition in order to avoid mistaking it with other abdominal diseases. However, diagnosis is rarely made preoperatively.