Simultaneous Intussusception and Volvulus in an Adult Due to a Congenital Fibrous Band

Case report A 72-year-old woman was admitted as an emergency with a lO-day history of right-sided abdominal pain and vomiting. Two days prior to admission she had passed blood stained diarrhoea, since which time she had developed absolute constipation. On examination she appeared unwell. She was dehydrated and emaciated. Her pulse was no beats/minute. BP 140/90 mmHg and temperature 37°C. She was very tender over the right side of her abdomen with marked guarding and rebound tenderness. A mass was present in her right iliac fossa. Bowel sounds were obstructive in nature. Normal coloured faeces were found on P. R. examination. Radiological examination showed small bowel obstruction and biochemical analysis of her blood confirmed the clinical finding of dehydration. There was no history of previous abdominal surgery or of pelvic sepsis. At laparotomy there was a gangrenous segment of bowel extending from terminal ileum to proximal ascending colon. The distal part of the small bowel mesentery appeared twisted at its base and there was an ileo-caecal intussusception. The gangrenous segment was resected with end-to-end anastomosis of ileum to distal ascending colon. A drain was inserted and the wound closed. The patient made an uncomplicated postoperative recovery and was discharged home after 12 days. She was reviewed six weeks later in the out-patient clinic at which time she was well and her wound soundly healed.