Idiopathic adult ileo‐colonic intussusception

A 56yearold woman with a 10year history of eating disorders and alcohol dependence was admitted at another hospital for the treatment of emaciation. Her body weight was 54 kg in her 20s. On admission, her body weight was 31 kg and her height was 153 cm (body mass index, 13.2). Intravenous hyperalimentation was initiated; however, liver dysfunction, peripheral edema, and ascites appeared 2 weeks later. As refeeding syndrome was suspected as the cause of her liver dysfunction, calories infused per day were reduced. Subsequently, peripheral edema and ascites worsened. In addition, she experienced abdominal fullness, distention, and nausea after defecation using a suppository and glycerin enema. Four weeks after admission to the hospital, she was referred to our hospital for further investigation and treatment of emaciation, liver dysfunction, ascites, and abdominal symptoms. On physical examination, her abdomen was distended without tenderness or palpable tumors. Her bowel sounds were increased but there were no metallic sounds. Laboratory testing revealed an exacerbating increase of liver enzyme levels: aspartate aminotransferase, 305 U/L; alanine aminotransferase, 634 U/L; alkaline phosphatase, 996 U/L; and γglutamyl transpeptidase, 122 U/L. Contrastenhanced computed tomography (CT) scanning revealed ileocolonic intussusception in which the ileum extended to the hepatic flexure of the ascending colon (Figure 1, arrow). Although initially considered, surgical management was waived because of multiple risks with general anesthesia, such as emaciation and liver damage, and there were no signs of intestinal ischemia. Colonoscopy performed after a highpressure enema with 500 mL water revealed that the intussusception was resolved and the ileal mucosa was reddish and edematous. Endoscopic ultrasonography (Figure 2), video capsule enteroscopy, and CT scanning (Figure 3) performed after the resolution of the intussusception showed only