Rare Double-Site Intussusception With Volvulus Reported in a Healthy 26-Year-Old: Case Report

Intussusception—where one segment of the intestine telescopes into another—is commonly seen in children but is rare in adults, accounting for fewer than 5% of all cases. In more than 90% of adult presentations, an underlying structural lesion such as a tumor serves as a lead point. Idiopathic cases without any identifiable cause are extremely uncommon.

The patient presented with a three-day history of worsening abdominal pain accompanied by vomiting. Clinical evaluation revealed signs of peritonitis, raising concern for intestinal ischemia or perforation. Given the severity of symptoms, the surgical team proceeded directly to emergency laparotomy.

Intraoperatively, surgeons discovered two separate jejunoileal intussusceptions occurring simultaneously. Both segments were associated with volvulus—a twisting of the intestine that compromises blood flow—and had progressed to transmural ischemic necrosis. Notably, there was no evidence of bowel perforation. Despite a thorough inspection, no structural abnormality or pathological lead point was identified in either segment.

The affected bowel sections were resected, and continuity was restored using stapled anastomoses. The patient recovered without complications and was discharged in stable condition. Follow-up evaluations confirmed complete recovery with no recurrence of symptoms.

Histopathological examination of the resected tissue showed full-thickness ischemic necrosis but no signs of malignancy, inflammation, or infection. Microbiological cultures were negative, further supporting the idiopathic nature of the condition.

According to the authors, this case stands out due to the combination of multifocal small bowel intussusception, concurrent volvulus, and extensive necrosis in the absence of any detectable structural cause. Such a presentation challenges the conventional understanding that adult intussusception is almost always linked to an underlying lesion.

The report underscores an important clinical message: in adults presenting with acute abdomen and signs suggestive of bowel ischemia, urgent surgical exploration should take precedence over prolonged diagnostic imaging. Delays in operative management may increase the risk of morbidity and mortality.

By documenting this rare constellation of findings, the authors broaden the clinical spectrum of idiopathic adult intussusception and emphasize that severe small bowel emergencies can arise even in young, otherwise healthy individuals without identifiable pathology.