S6416 The Stomach Within Itself: A Rare Case of Gastrogastric Intussusception in a Patient With Short Bowel Syndrome

Introduction: Gastrogastric intussusception is a rare entity in adults, occurring when the stomach telescopes into itself, most often due to an identifiable lead point such as a polyp or tumor. While intussusception commonly affects the small or large intestine, gastric involvement is uncommon and typically presents in older females. We report a rare case of spontaneous gastrogastric intussusception associated with small bowel obstruction in a patient with short bowel syndrome, highlighting a transient, non-neoplastic etiology. Case Description/Methods: A 67-year-old woman with a history of multiple small bowel obstructions, prior abdominal surgeries, and short bowel syndrome presented with acute-onset colicky epigastric pain, nausea, and bilious vomiting. She reported no flatus and 1 loose bowel movement the day before, consistent with her baseline. She was hemodynamically stable, with epigastric tenderness but no distension. Bowel sounds were present in the upper quadrants. Computed tomography (CT) imaging revealed a small bowel obstruction with a transition point near the umbilicus, and a proximal gastric invagination suggestive of gastrogastric intussusception. Labs were unremarkable except for mildly elevated alanine transaminase (44 U/L); lactate was normal. She was managed conservatively with nil per os (nothing by mouth), intravenous fluids, pain control, and antiemetics. Gastroenterology and surgery were consulted. Esophagogastroduodenoscopy (EGD) showed no active intussusception but revealed mild gastritis with small antral erosions and no mass. Her symptoms resolved without intervention. The intussusception was presumed to be transient, secondary to increased intra-abdominal pressure from the obstruction. Discussion: Gastrogastric intussusception is exceedingly rare, with only 22 cases reported in the literature between 1950 and 2024. Our case stands out as 1 of only 2 documented instances of gastrogastric intussusception in the setting of small bowel obstruction without an anatomical lead point. This case highlights the importance of recognizing non-neoplastic, pressure-mediated etiologies, particularly in patients with altered gastrointestinal anatomy and motility. Radiologic imaging is pivotal in diagnosis, with CT showing classic signs such as the “target” or “pseudokidney” appearance. While adult intussusception often warrants surgery, our patient improved with conservative management alone. This highlights the potential role of non-operative strategies in carefully selected cases. Given her recurrent obstructions, vigilant follow-up remains crucial.