Intussusception in a Young Patient with Ulcerative Colitis

Abstract

Intussusception in adults with inflammatory bowel disease is very rare. Eight cases have been reported with only three described in patients with ulcerative colitis. The lead points for the intussusception were pseudopolyps and recommended management was to resect the involved bowel without attempts at reduction. We report a 24-year-old woman with ulcerative colitis and sickle cell disease admitted with abdominal pain. She was diagnosed with ulcerative colitis 10 years previously when she presented with bloody diarrhea and abdominal pain. An incomplete colonoscopy was performed (secondary to patient discomfort), and revealed ulcerative colitis. Asacol was prescribed and taken in unknown dosage for 1 ½ years. She had multiple flares of disease activity over the years, characterized by abdominal pain and bloody diarrhea; each was treated with slow tapering prednisone regimens. She presented to our medical center with two days of unusually sharp right upper and lower quadrant abdominal pain associated with nausea, but without diarrhea, rectal bleeding or fever. A CT Scan revealed enlargement of the right and proximal transverse colon with intraluminal fat consistent with ileocolic intussusception (Figure 1). The patient underwent a right hemicolectomy without reduction of the intussusception. Examination of the removed colon revealed a 5 cm polyp in the terminal ileum consistent with a tubular adenoma that served as the lead point. Pathologic evaluation showed chronic inflammatory changes with intramucosal carcinoma. Three other polyps approximately 2 cm in size consistent with tubular adenomas were noted in the ascending colon. Given the findings on pathologic evaluation, should the patient have had a total colectomy? Intussusception is a rare complication of inflammatory bowel disease and treatment should incorporate optimal management of the underlying disease and the intussusception. [figure 1][figure 2]Figure 1Figure 2