Intussusception: An Initial Presentation of Colorectal Malignancy at Young Age

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 or by postoperative condition. We report a similar case in a young adult presenting as intussusception with no family history of colon cancer. Case report: A 26 year old male with no family history of colon cancer presented with acute worsening of left lower quadrant abdominal pain that he was experiencing for three months. It was associated with diarrhea and constipation. His vitals were stable on presentation. Examination showed minimal tenderness in the left lower quadrant with no palpable mass. Labs were unremarkable except for mild microcytic hypochromic anemia. Abdominal CT scan showed intussusception along with regional pericolic lymph nodes. He was managed conservatively initially, as per surgical team recommendations. Subsequently, colonoscopy was performed which showed a 5 cm ulcerated, partially obstructing mass in the descending colon. Histopathology results showed tubulovillous adenoma with high grade dysplasia. CEA level was 9.6 ng/ml. Patient underwent laparoscopic left hemicolectomy later and biopsy results showed moderately differentiated invasive adenocarcinoma, mucinous type, with no lymphovascular or perineural invasion. Patient is now scheduled to follow up medical oncology for further management. Discussion: The interesting fact about this case is the diagnosis of colon cancer at very young age with no previous family history of colon cancer, which presented as intussusception. 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% cases are idiopathic. Malignant lesions account for up to 30 % of cases in small intestine and 66 % of the cases in the large intestine. Abdominal CT scan is diagnostic modality of choice in these patients. It may also help in defining the location, the nature of the mass and it may help staging the patient with suspected malignancy causing the intussusception. Intussusception associated with malignancy should be managed by multispecialty collaboration.Figure 1Figure 2Figure 3