1596 Adult Colocolic Intussusception: A Case Series

Abstract

INTRODUCTION: Intussusception of the bowel is defined as the telescoping of a proximal segment of the gastrointestinal tract within the lumen of the adjacent segment and is found frequently in children. It is less common in adults. Most of the intussusceptions in adults are caused by a definite underlying disorder such as neoplasm. CASE DESCRIPTION/METHODS: •A 26-year-old healthy male presented with acute left abdominal pain. Examination showed minimal tenderness in the left lower quadrant with no palpable mass. An abdominal CT scan showed intussusception along with regional pericolic lymph nodes. Colonoscopy was performed which showed a 5 cm ulcerated, partially obstructing mass in the descending colon. The patient underwent laparoscopic left hemicolectomy later and biopsy results showed moderately differentiated invasive adenocarcinoma, mucinous type, with no lymphovascular invasion. •A 44-years-old healthy male presented with severe abdominal pain and distention. Examination revealed severe abdominal tenderness and distention with diminished bowel sounds. Abdominal imaging revealed right-sided colocolic intussusception with possible underlying mass, dilated small bowel loops consistent with small bowel obstruction and innumerable hepatic metastases. The patient went for emergent right hemicolectomy. Pathology showed invasive adenocarcinoma of the cecum. The patient is planned for chemotherapy by oncology. •An 84-years-old female with no history of colonoscopy came for evaluation of right side abdominal pain. She had abdominal imaging which showed colocolic intussusception noted at the hepatic flexure with associated wall thickening, suggestive of underlying colonic mass. GI and Surgery evaluated the patient for endoscopic diagnostic workup and possible surgical intervention based on that but the family refused and opted for comfort care. DISCUSSION: Adult intussusception occurs relatively rarely; accounting for 5% of all cases of intussusceptions. A specific lead point is identified in more than 90% of cases while 10% of cases are idiopathic. Malignant lesions account for up to 30% of cases in the small intestine and 66% of the cases in the large intestine. An abdominal CT scan is the diagnostic modality of choice in these patients. It may also help in defining the location, the nature of the mass and it may help to stage the patient with suspected malignancy causing the intussusception. Intussusception associated with malignancy should be managed by multispecialty collaboration.