Colo-colic intussusception in an adult: case report and review of the literature

Abstract

Intussusception is rare in adults and is clinically distinct to its occurrence in the paediatric population. Appreciation of these differences by general surgeons is important in guiding management in the adult population. We report the case of a 37 year old presenting with abdominal pain and per rectal bleeding who was found to have transverse colonic intussusception on computed tomography (CT). Colonoscopy and biopsy confirmed a transverse colon adenocarcinoma for which he underwent laparoscopic extended right hemicolectomy. The existing literature around adult intussusception was reviewed. Intussusception presents non-specifically and often subacutely in adults, frequently being overlooked as a diagnosis in this population. Increased use of imaging, in particular CT, have improved preoperative diagnosis. Compared to the paediatric population where intussusception is overwhelmingly idiopathic, in adults it is often due to a pathological lead point, with a significant risk of underlying malignancy. Consequently, surgery without reduction is the mainstay of management in the adult population, in comparison to hydrostatic or pneumatic reduction in the paediatric population. Intussusception is a rare presentation in the adult population. It is commonly caused by a pathologic lead point and should raise suspicion of malignancy particularly when involving the colon. As a result, within the adult population, surgery is the mainstay of management, which can safely be performed laparoscopically.