P2085 - An Atypical Cause of Vomiting: Pyloric Intussusception

Camille H. Boustani, MD¹, Danial Nadeem, MD², Merwise Baray, MD^1
1MedStar Georgetown University Hospital, Washington, DC; ²MedStar Washington Hospital Center, Washington, DC

Introduction: Intussusception in adults occurs rarely, representing only 5% of all cases of intussusception and 1% of all cases of bowel obstruction. Gastroduodenal intussusception accounts for less than 10% of all cases in adults. We present the case of a patient with nausea and vomiting, found to have pyloric intussusception.

Case Description/Methods: A 72-year-old male with history of robotic partial right nephrectomy for an enlarging right renal mass, complicated by duodenal perforation and repair, presented to the hospital for 2 days of intractable nausea and vomiting. The patient was discharged 2 months prior, following his nephrectomy requiring duodenal repair. He underwent primary repair with Graham patch, involving the D1-D2 segment of the duodenum. On this admission, the patient reported burning epigastric pain, inability to tolerate oral intake, and vomiting. CT scan of the abdomen and pelvis showed intussusception of the pylorus into the duodenal bulb, with inflammatory changes surrounding the second portion of the duodenum and stranding of the adjacent fat. The gastroenterology team was consulted and recommended an upper GI series with small bowel follow through to further characterize the area. It demonstrated a normal appearance of the duodenal loop, and no evidence of obstruction or perforation. The following day, EGD showed gastritis and duodenitis, but no obvious lead point or mass to have caused the intussusception. Biopsy showed only chronic inactive gastritis, and chronic duodenitis with preserved villous architecture. Specimens were negative for dysplasia and H. pylori. The patient improved, with vomiting resolved, and he began tolerating normal oral intake. He was discharged home 4 days following admission.

Discussion: Gastroduodenal intussusception has been described in the literature as an infrequent form of intussusception and is usually linked to a malignancy. A lead point is usually identified in 70% to 90% of adult intussusception cases, and 65% of these cases are secondary to benign or malignant neoplasms. We present a distinct case of pyloric intussusception 2 months following duodenal perforation and repair, with a lead point presumed to be the inflammatory changes and adhesions related to the surgery.


Figure: CT scan of the abdomen with arrow indicating the area of pyloric intussusception.


Disclosures:
Camille Boustani indicated no relevant financial relationships.
Danial Nadeem indicated no relevant financial relationships.
Merwise Baray indicated no relevant financial relationships.


Camille H. Boustani, MD¹, Danial Nadeem, MD², Merwise Baray, MD¹. P2085 - An Atypical Cause of Vomiting: Pyloric Intussusception, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.