%0 Journal Article
%T Idiopathic adult intussusception
%A Sanooj Soni
%A Philip Moss
%A Thiagarajan Jaiganesh
%J International Journal of Emergency Medicine
%D 2011
%I BioMed Central
%R 10.1186/1865-1380-4-8
%X A 26-year-old male, with no prior medical history, presented to the emergency department with a 24-h history of bouts of severe colicky abdominal pain, worse in the left lower quadrant. The symptom had initially started with vomiting just prior to the abdominal pain. He subsequently developed some diarrhoea, further episodes of vomiting and began to feel unwell with a fever. He was unable to tolerate even oral fluids, which had prompted his presentation to the ED that morning. There was no episode of rectal bleeding. His temperature was 38¡ãC, pulse of 120 beats per minute and a respiratory rate of 28 breaths per minute. He remained normotensive and maintained good oxygen saturations. Examination revealed a soft abdomen but gross tenderness in the lower quadrants, worse in the left iliac fossa. There was no palpable mass, and rectal examination did not demonstrate any blood. Bowel sounds were present and there were no clinical signs of peritonitis. After blood investigations were sent, he was treated with intravenous paracetamol, hyoscine butylbromide and intravenous fluids. He was sent for an abdominal x-ray, which revealed a single dilated loop of small bowel (3 cm) in the central abdomen with scanty bowel gas elsewhere (Figure 1). He subsequently was given opioid analgesia as his pain was increasing in severity.An arterial blood gas on air analysis revealed a respiratory alkalosis (pH 7.650, pCO2 2.33 kPa, pO2 14.0 kPa, base excess 1.5 mmol/l and bicarbonate 25.6 mmol/l). He had a raised lactate level of 3.5 mmol/l. Other blood tests illustrated raised acute inflammatory markers such as C-reactive protein of 231.7 ng/ml, and a white cell count of 15.9 ¡Á 109/l with a neutrophil count of 13.7 ¡Á 109/l. Given his extreme pain, fever and raised lactate level, a clinical diagnosis of intra-abdominal sepsis secondary to gut ischaemia was made and the patient referred to the surgical team. A preoperative CT scan of his abdomen revealed an ileo-ileal intussusception with s
%U http://www.intjem.com/content/4/1/8