98 Bombay Hospital Journal, Special Issue, 2009 An Unusual Case of Intussusception in A Case of Abdominal Tuberculosis with HIV Disease MJ Algotar*, Praveen Tunganwar**, Ashish Dey***, Preveen Bijwe***, Mujtaba Shaikh*** Abstract Intussusception is a condition where a segment of bowel ‘telescopes’ into the lumen of the immediately adjacent part. A condition which is mostly idiopathic in children, less than 2 years but associated with some pathology in older patients. Among the pathologies that initiate the process of invagination, the most common ones are lymphomas, Meckel’s diverticulum, hama- rtomatous polyps, haemangiomas and inverted appendiceal stumps. Most cases occur in other- wise healthy male children and are commonly of ileo-colic type. In idiopathic cases it is suggested that hypertrophy of the Payer’s patches in the terminal ileum from an antecedent viral infection acts as the starting point. Peristaltic action of the intestine then causes the bowel to prolapse into the lumen adjacent to it. In contrast to the conservative approach by hydrostatic reduction in case of children less than 2 years, the definitive treatment for adult intussusception is operative intervention. Introduction A dult intussusception is very rare. Various references reveal the following data. - Only 13 cases of adult intussusception were reported over a period of 13 year by Begos et al. - Moreover only 58 adult cases of intussusception were seen at Massachusetts general hospital over a 30 year time span. - Only 34 cases were reported in Cornwel Medical Centre, New York over 36 years. Majority of adult intussusception has a definitive cause. Benign and malignant intraluminal masses such as lipomas, adenocarcinomas and metastatic melanomas are the most frequent lead points of such intussusception. In one such study the incidence of appendiceal intussusception was only 0.01%. 4 The diagnosis of such an intussusception is difficult and only made during surgery. Tumours caused around 63% of adult intussusception. Malignancy is higher in colonic (33%-77%) than for small bowel intussusception (10%-50%). 5 A comparative study conducted separately to know the aetiological factors and their incidence is shown below. A survey by Huang, Deptt of internal medicine in Chang Gung Memorial Hospital, Taiwan showed the following results. 1 Data obtained from 45 cases of adult intussusception proven by surgery was collected from 58000 surgeries. Their results are shown below. Although ileo-colic intussusception remains the most common cause of intussusception in both adults and infants, the incidence of colo-colic intussusception in adults is 8%-19% *Professor and Head of the Unit, **Lecturer, ***Resident, Dept. of General Surgery, JJ Group of Hospitals, Byculla - 400 008. Reprinted from : BHJ 2006; 48 (4) : 689-91