Adult Ileocolic Intussusception Secondary to an Inflammatory Fibroid Polyp of the Terminal Ileum Presenting as Acute Small Bowel Obstruction: A Case Report

Intussusception in adults is an uncommon cause of intestinal obstruction and is usually associated with an underlying structural lesion, unlike pediatric cases. In most adult patients, a pathological lead point is identified, frequently neoplastic in origin, making surgical management the standard treatment. We present the case of a 66-year-old man with a history of type 2 diabetes mellitus who presented with colicky abdominal pain, vomiting, and hematochezia. Physical examination revealed abdominal distension, tympany, diffuse tenderness, rebound tenderness, and hyperactive bowel sounds. Computed tomography demonstrated dilated small bowel loops with a transition zone and findings suggestive of ileocolic intussusception causing mechanical bowel obstruction. An exploratory laparotomy was performed, revealing ileocolic intussusception associated with two lesions in the terminal ileum located 15 and 25 cm from the ileocecal valve. Segmental resection of 30 cm of the terminal ileum with distal closure, terminal ileostomy, and incidental appendectomy was carried out. Histopathological examination reported an inflammatory fibroid polyp measuring 4 × 2.3 cm associated with ulcerated ischemic ileitis, without compromise of surgical margins. Adult intussusception should be considered secondary to an organic lesion until proven otherwise. Prompt diagnosis with computed tomography and early surgical intervention are essential to prevent ischemic complications. Although rare, inflammatory fibroid polyps may act as a pathological lead point for intussusception and bowel obstruction.