1. Intussusception Rory Murphy

2. History. HPC 80 ♂ 4/7; general malaise. 1/7; nausea, profuse vomiting, diarrhoea & “crampy” lower abdominal pain. Recent campylobacter gastroenteritis. PMHx Chronic Renal Failure. (Dialysis* 3 a week.). HTN

3. Physical Exam. Vitals. HR 80 Hypertensive Apyrexial SaO2 95% Abdominal, Soft Non-tender. No gaurding, rigidity or organomegaly, Hernial orifices clear. BS+ PR/FOB not documented

4. Initial Investigations. Bloods. Hb 13 WCC 7.78 Neutophils 6.7 Urea 31 Na 134 Creat 848 LFT’s NAD Amylase CRP 26 Stool Culture,Ova&Oocytes. Neg Imaging. PFA: No gaseous distension of the bowel. Abdominal U/S: NAD. OGD; Hiatus Hernia Mild Antral Gastritis

5. Initial Differential Diagnosis and Treatment. Post-Infectious gastroenteritis/Malabsorptive State. Nausea and Vomiting intermittently. 9 days post admission symptoms improved. Resolved gastroenteritis. Aspiration pneumonia.

6. Repeat Investigations. PFA x 2 revealed dilated loops of small bowel. However clinical discordence patient passing bowel motions and non distended.

7. Intra-operative Images.

8. Intussusception exists when a proximal segment of bowel (intussusceptum) telescopes into the lumen of the adjacent distal segment. 1 % of all bowel obstructions, 5% of all intussusceptions, Adult Intussusception.

9. Intussusception is a different entity in adults than it is in chlidren. Pathology is found in 70% to 90% of cases in the adult population. Intraluminal lesions alter normal bowel peristalsis and form leading edges for the intussusceptum. 9'0

12. Adults may present with acute, intermittent, or chronic reported problems." The predominant symptoms usually are those of bowel obstruction and, consequently,intussusception often is misdiagnosed initially in the adult population.