A Woman with Abdominal Pain

A 28-year-old woman with a history of cocaine and opioid use disorder presented to the emergency department with abdominal pain, nausea, and vomiting for two days. She'd had irregular bowel movements with constipation for quite some time. Physical exam was notable for diffuse peritonitis and melena on digital rectal exam. Patient had a witnessed episode of hematochezia. Computed tomography of the abdomen and pelvis with intravenous contrast demonstrated sigmoid colon intussusception, and the patient underwent emergent surgery for definitive treatment. Specimen was sent to surgical pathology and revealed no lead point.

While sigmoid intussusception is not a rare finding, it is exceedingly rare in young adult patients who do not have a pathologic lead point. Lead points are areas of inflammation, lesions, or masses that snag the bowel and initiate the process of telescoping that ultimately results in an intussusception. This patient was not found to have such a lead point on gross examination during surgery or on extensive specimen examination in the pathology lab. Instead, her sigmoid intussusception is hypothesized to be secondary to decreased gut motility in the setting of chronic opioid use disorder.