Clinical Practice and Cases in Emergency Medicine

Introduction: Adult ileocolic intussusception is rare and typically associated with a pathological lead point. Diagnosis can be challenging in the emergency department (ED), particularly when initial vital signs and laboratory studies are reassuring. Point-of-care ultrasound (POCUS) may allow for earlier recognition and expedited management.

Case Report: A woman with ulcerative colitis presented to the ED with abrupt, severe, waxing-and-waning abdominal pain. Initial vital signs and lab studies were normal. Bedside POCUS performed at the point of maximal tenderness revealed a target sign in the right mid-abdomen, prompting concern for intussusception. This finding was used to advocate for urgent surgical evaluation and expedited computed tomography of the abdomen and pelvis, which confirmed ileocolic intussusception with early distal small-bowel obstruction and no identifiable mass. Despite reassuring objective data, the patient’s persistent severe pain and serial examinations raised concern for evolving ischemia. Following continued emergency physician advocacy, the patient was admitted for operative management. Diagnostic laparoscopy was converted to open laparotomy, during which manual reduction and right hemicolectomy were performed for an ischemic, near-perforated colon, followed by creation of an end ileostomy and mucus fistula. The patient recovered well postoperatively. She had been taking curcumin–qing dai (CurQD) for ulcerative colitis, a supplement with rarely reported associations with intussusception.

Conclusion: This case highlights the value of emergency POCUS in identifying high-risk abdominal pathology, the importance of early surgical involvement despite reassuring initial tests, and a potential supplement-associated risk factor in patients with inflammatory bowel disease.