Adult Colonic Intussusception Caused by Mucinous Adenocarcinoma: Report of a Case

Abstract

Adult colonic intussusception occurs infrequently and differs from childhood intussusception in its presentation, etiology, and treatment. Diagnosis can be challenging and may be delayed because of longstanding, intermittent, and non-specific symptoms. Most cases are diagnosed at emergency laparotomy. With more frequent use of computed tomography in the evaluation of patients with abdominal pain, the condition can be diagnosed more reliably. The effective management remains controversial. Treatment entails simple bowel resection in most cases. Reduction of the intussusception before resection is controversial, but there is a shift against this, especially in colonic cases. We present a case of a seventy-three-year-old healthy man who presented with a ten day history of recurrent generalized abdominal pain and obstructive symptoms. We present the classical CT appearance of intussusception, a classic target lesion, suggesting colonic intussusception (Descending-colon to Sigmoid-colon image), alongside intra-operative visual images highlighting this rare and extensive segment of D-colon intussuscepting to the proximal S-colon. Anterior resection (standard operation for S-colon cancer) was performed. Pathology showed a large mucinous adenocarcinoma with moderate differentiation sitting at the advancing tip of the intussuscepted fragments and hence acting as the lead point. Post-operatively, our patient has done well and there were no issues of concern.