Carolinas Medical Center Charlotte, NC, United States
Shanti Rao, MD, Nilesh Lodhia, MD Carolinas Medical Center, Charlotte, NC
Introduction: Intussusception of the gastrointestinal tract in adults is typically associated with intraluminal malignant tumors. There are very few reports of intussusception without a polypoid lead point, particularly in an asymptomatic patient. This is a case of incidentally found gastro-gastric intussusception in an asymptomatic patient in the setting of trauma from a motor vehicle accident.
Case Description/Methods: A 26-year-old woman with no past medical history presented to the hospital after an unrestrained motor vehicle collision resulting in the patient being expelled from the vehicle. She was found to have a C3-C4 fracture with dislocation resulting in spinal cord injury leading to quadriplegia. Upon admission, computed tomography (CT) scan revealed a gastro-gastric intussusception.
Gastroenterology was consulted for the CT scan findings. A nasogastric (NG) tube had been placed by the primary team, and she was otherwise tolerating her own secretions without abdominal pain. The patient underwent an esophagogastroduodenoscopy (EGD) which showed a J-shaped stomach with an intact NG tube. There was evidence of some mucosal erosions that could have been consistent with prior gastro-gastric intussusception.
No treatment was necessary as the intussusception had spontaneously resolved and the patient was tolerating oral feeds and secretions.
Discussion: Intussusception in an adult is rare, making up 5% of all cases. The majority of cases are caused by an underlying neoplasm or post-operative anatomy, and occur most frequently in the small bowel. 10% of reported cases occur in the stomach.
This case re-enforces trauma as a potential cause of gastrointestinal intussusception, and should be on the differential in a patient presenting with abdominal pain, nausea, and vomiting after a traumatic event. This patient did not have a lead point seen on endoscopy, although her J-shaped stomach may have increased her risk for intussusception. Hiatal hernia is also a known risk factor in the absence of a lead point, although this was not seen in this patient. It is likely that increased intra-abdominal pressure from trauma as well as her existing anatomy led to gastro-gastric intussusception that resolved spontaneously as the patient was resuscitated.
Figure: Image 1: A, B, and C. CT scan findings of gastro-gastric intussusception with the arrow pointing to the area of the stomach involuted into itself. D. Endoscopic finding of J-shaped stomach without evidence of intussusception.
Disclosures: Shanti Rao indicated no relevant financial relationships. Nilesh Lodhia indicated no relevant financial relationships.
Shanti Rao, MD, Nilesh Lodhia, MD. P1037 - A Case of Traumatic Gastric Intussusception, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.