Discussion:
When there is one segment of the bowel that invaginates into another
portion, this process is named as intussusception. During
intussusception, venous outflow will be obstructed due to edema which
will lead to ischemia, necrosis and perforation.4 The
highest incidence of intussusception falls in the first two year of
life. It is considered as the most common cause of bowel obstruction
during infancy.5 However, some studies showed that
intussusception can occur at older age and should be considered as
differential diagnosis in all age groups (up to 23% of all
intussusceptions). 6 With aging, the intussusception
tends to be due to pathological leading point. Those points including
carcinoid tumors, leiomyoma, small bowel lymphoma, vascular
malformations, inverted appendiceal stumps or MD.7Furthermore, intussusception’s leading point can be part of systematic
disease such as Henoch-Schönlein purpura,cystic fibrosis , and
hemolytic-uremic syndrome.8 MD is considered as the
most common gastrointestinal tract (GIT) congenital
anomaly.9 It is resulted from incomplete obliteration
of the vitelline duct which leads to formation of diverticulum. The MD
is true diverticulum which containing all layers of small
bowel.9 Prevalence of MD is estimated up to 2 percent
in general population.10 Out of this percentage, only
approximately 2 to 4 percent of patients develop a complication in their
lifetime, specially before two years old.11 The rule
of two in MD are two inches in length, two feet from the ileocecal
valve, two percentage of population and two ectopic
mucosa.12 The presentation of MD intussusception
varies between the age groups, in first two year of life, classic triad
of vomiting, abdominal pain, and bloody stools are expected. However, as
patient grows the presenting symptoms becoming
vaguer.13 The complications of MD include bleeding,
obstruction, inflammation and perforation. One of the causes of MD bowel
obstruction is intussusception. 2 Since most MDs are
asymptomatic and most intussusceptions are of unknown cause, MD causing
small bowel intussusception is extremely rare. Despite the rarity of the
condition, this case report is demonstrating the importance of
considering such diagnosis in this age group. Unlike pediatric
intussusception, once the diagnosis of intussusception is made in adult,
surgery is the standard of care. Inspection of involved segment should
be made, and the resection depends on the viability of the bowel
segment.14 Back to our case, the diagnosis of MD was
not certain, and the involved segment was not healthy therefore
resection was done.