Chronic Recurrent Intestinal Intussusception

Abstract

ALTHOUGH chronic recurrent intussusception of the large bowel is uncommon, it must be considered in the differential diagnosis of obscure intra-abdominal conditions. The writers have had the opportunity of observing eight cases diagnosed radiographically and confirmed by operation. Each patient was examined by means of a barium meal from above, as well as by opaque enemas, post-enema radiograms, and barium-air contrast enema radiograms. Repeated examinations were made in several instances. The post-evacuation and barium-air contrast enema studies were so helpful in establishing the diagnosis that we now regard them as indispensable. Seven patients had cecocolic intussusception secondary to cecal tumors. In these cases, the ileum also intussuscepted. Pathologic examination revealed five adenocarcinomas and two leiomyosarcomas. The eighth patient had a colocolic invagination associated with a pedunculated leiomyosarcoma arising from the hepatic flexure. The association of chronic large bowel intussusception with leiomyosarcoma is unusual. We have been unable to find reports of similar cases in the available literature. Symptomatology.—The clinical picture of the seven patients with ileocecocolic intussusception was essentially the same. All complained of more or less persistent pain in the right lower quadrant, radiating to the epigastric and substernal regions. The pain varied considerably in intensity at different times. Nausea and anorexia were frequent. Vomiting and bloody stools were often observed. There were relatively long intervals of freedom between the acute episodes, and cathartics on occasion aggravated the symptoms. The history presented by the patient with colocolic invagination was somewhat more acute, only one attack of persistent right upper quadrant pain occurring before surgical intervention. The chronicity of the symptoms, repeated subacute episodes, and the changing radiographic findings are in contrast with the syndrome usually observed in the acute forms of intussusception. The relationship between the size of the intussuscipiens and intussusceptum no doubt plays an important role in the severity of the symptoms. In this connection Ehnmark (1) recalls that the large and small bowel of children are approximately the same size, whereas the large bowel of an adult is about three times as large as the small. Hence an intussusception in an adult involving the presence of ileum within the large bowel may be expected to produce symptoms of less severity than a colocolic invagination. This is supported by the findings in the cases here reported, in which the patients with ileocecocolic invagination had relatively chronic courses while the patient with colocolic invagination had but one attack before operation.