Can Bowel Intussusception Occur in Crohn's Disease Without GI Symptoms?
Yes, intussusception can occur in Crohn's disease without typical gastrointestinal symptoms, though this is rare and represents an atypical presentation that should prompt immediate imaging and surgical evaluation.
Clinical Presentation Patterns
Typical vs Atypical Presentations
Most intussusception cases in Crohn's disease present with obstructive symptoms including abdominal pain, nausea, vomiting, and features of bowel obstruction, which are distinct from the chronic diarrhea, bloating, or constipation typically associated with active inflammatory disease 1, 2.
Intussusception can occur as an initial manifestation of Crohn's disease before any chronic GI symptoms develop, as documented in cases where patients presented with acute abdominal pain and imaging findings of intussusception, with IBD only diagnosed after histological examination 3, 4.
Documented cases exist of Crohn's disease presenting with extraintestinal manifestations alone—including fever, musculoskeletal pain, and hepatic abscesses—without any gastrointestinal symptoms whatsoever, confirmed only after imaging revealed small bowel disease 5.
Mechanism of Intussusception in Crohn's Disease
Intussusception in adults is secondary to organic lesions in 80-92% of cases, with inflammatory bowel disease recognized as a causative factor alongside strictures, adhesions, and mass lesions 2.
Giant pseudopolyps and inflammatory masses in Crohn's disease serve as lead points for intussusception, creating mechanical obstruction that may present acutely rather than with chronic inflammatory symptoms 6.
The structural changes from Crohn's disease—including strictures, fistulae, and inflammatory masses—create anatomical conditions favoring intussusception independent of active mucosal inflammation or typical GI symptoms 1, 7.
Diagnostic Approach
Imaging as First-Line Investigation
Contrast-enhanced CT is the most sensitive diagnostic modality for detecting intussusception and can distinguish between cases with and without a lead point, making it essential when acute abdominal symptoms occur in known or suspected Crohn's patients 2.
MR enterography should be performed when Crohn's disease is suspected to identify structural abnormalities including strictures, fistulae, and inflammatory masses that could serve as lead points for intussusception 7, 8.
Clinical Red Flags
Acute onset of cramping abdominal pain with or without a palpable mass should raise suspicion for intussusception, even in the absence of diarrhea, constipation, or bloating 2.
Obstructive symptoms (nausea, vomiting, inability to pass stool or gas) warrant immediate imaging rather than empiric treatment for active IBD, as these suggest mechanical rather than inflammatory pathology 1.
Unexplained fever, extraintestinal manifestations, or systemic symptoms without GI complaints should prompt cross-sectional imaging to evaluate for occult small bowel Crohn's disease with complications 5.
Management Considerations
Surgical Intervention
Surgery is the definitive treatment for adult intussusception, with formal bowel resection recommended when malignancy cannot be excluded or when the bowel is non-viable 2.
Reduction prior to resection may be considered in Crohn's patients with viable bowel to preserve intestinal length and avoid short bowel syndrome, particularly important given the chronic nature of the disease and risk of future resections 4.
Endoscopic reduction using water immersion has been successful in selected cases of colo-colonic intussusception without structural lead points, though this requires careful patient selection and experienced endoscopists 3.
Common Pitfalls
Assuming all abdominal symptoms in Crohn's patients represent active inflammation can delay recognition of mechanical complications like intussusception that require surgical rather than medical management 1, 2.
Failing to obtain cross-sectional imaging when obstructive symptoms are present may result in missed diagnosis of intussusception, particularly in patients with known stricturing disease 7.
Not considering Crohn's disease in patients presenting with intussusception without prior GI symptoms, as this can be the initial manifestation requiring histological confirmation after surgical intervention 3, 4.