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Session: ePoster: IBD 4 (Mon1015)

EP726 - Active Crohn’s Disease Presenting as Ileo-ileal intussusception: a case report

Monday, May 12, 2025
10:20 AM - 10:25 AM PT
Location: Monitor 7, Sails Pavilion, Upper Level

    ePoster Presenter(s)

  • Rosa I. Alers-Talavera, MD

    Fellow
    Greater Baltimore Medical Center
    Towson, MD, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    View ePoster

    • Senior Author(s)

  • GA

    George Y. Apostolides, MD

    Head of Section of Colon And Rectal Surgery/ Program Director of the Colon and Rectal Program
    Greater Baltimore Medical Center
    Baltimore, Maryland, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.
Rosa I. Alers-Talavera, MD: This individual has no financial relationships with ineligible companies.
George Y. Apostolides, MD: This individual has no financial relationships with ineligible companies.
Purpose/Background: Intussusception in adults is usually associated with malignancy and mandates surgical intervention as part of its management. However, active Crohn's disease could also present as a lead point that could lead to this phenomenon.

Methods/Interventions: Case of a 71-year-old male patient with Crohn's disease diagnosed in the late 80s, with a previous surgical history of exploratory laparotomy with small bowel resection for management of peritonitis two years after diagnosis. The disease remained under control with biologic therapy during recent years until four months before our evaluation, when the patient started presenting with lower abdominal pain, constipation, and burning. CT Enterography showed abnormal dilation of the anastomotic site containing stool and a short segment of decompressed small bowel.

Results/Outcomes: The patient was taken to the operation room for exploratory laparotomy with small bowel resection and repair of a ventral hernia with mesh. During the procedure, a large (12.6 x 7.8 x 7.4  cm) mass-like segment of the small bowel was found as a point of transition; it was resected, and anastomosis was created. Pathology showed "Active Crohn's disease with multiple ulcerations, including a large deep ulcer extending into muscularis propria. Prior anastomotic site showing ulceration, fibrosis, and focal pyloric gland metaplasia." Post-operative course unremarkable. Patient discharged at POD 3. Reports resolution of symptoms and adequate state of health at clinic follow-up.

Conclusion/Discussion: While intussusception is more common in pediatric patients, its occurrence in adults, particularly in association with Crohn's disease, is rare. It can be triggered by various factors, including inflammation, fibrosis, ulcers, and strictures that act as lead points for the telescoping segment of the bowel. In this case, the patient presented with symptoms consistent with both Crohn's disease and intussusception. The rarity of this combination often leads to delayed diagnosis, as the symptoms of intussusception, such as abdominal pain, nausea, and vomiting, are nonspecific and can overlap with Crohn's disease flares.

Gross Pathology Speciment
Segment of small bowel packed with nearly solid stool in the dilated area. The mucosa in the dilated area shows multiple ulcerations.

Abdominopelvic CT Scan
Abnormal dilation of the anastomotic site containing stool and a short segment of decompressed small bowel.