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.