1491 Colo-Colonic Intussusception: An Unusual Complication of Bowel Preparation

Abstract

INTRODUCTION: Intestinal intussusception is the telescoping or invagination of a proximal bowel segment into a distal segment. It is a relatively common entity in the pediatric population, but only about 5% of all intussusceptions occur in adults. Approximately 90% of adult intussusceptions are secondary to an anatomical or pathological condition. We present a case of colo-colonic intussusception induced by bowel preparation for colonoscopy in the setting of large transverse colonic mass. CASE DESCRIPTION/METHODS: A 57-year-old gentleman with a history of metastatic melanoma was evaluated for iron deficiency anemia. On physical examination, the patient was pale and chronically ill appearing with a benign abdominal exam. Endoscopic evaluation showed an ulcerated mass in the duodenum and a large 5 cm tumor in the proximal transverse colon. While undergoing bowel preparation for repeat colonoscopy to assess response to chemotherapy, the patient developed acute, diffuse abdominal pain associated with nausea and vomiting. He was found to have an acute colo-colonic intussusception with total colonic obstruction. The patient underwent emergent surgery and recovered well. DISCUSSION: We hypothesize that our patient's colo-colonic intussusception was induced by hyperperistalsis of the colon as a result of bowel preparation. The patient was already at risk for both small bowel and colonic intussusception given the large size of both intestinal masses. Our case is unique in that he developed the intussusception while taking the bowel preparation. The altered peristaltic activity of the bowel in the setting of a large colonic mass created an area of constriction and distal relaxation which led to the invagination of the proximal bowel segment into the distal segment. With advances in endoscopy and new techniques, such as endoscopic submucosal dissection, we have the ability to remove larger polyps measuring more than 5 cm in size. Endoscopists need to inform their patients of the potential complication of bowel preparation induced colonic intussusception requiring emergent surgery while prepping for large polyp removal.