Massive Colonic Intussusception Demonstrated on CT When Abdominal X-ray Suggested Sigmoid Volvulus

Abstract

Purpose: Describe a case of colonic intussusception with colon cancer as a lead point discovered on CT when initial abdominal film was suggestive of sigmoid volvulus. Case: A 36-year old male was referred for evaluation of chronic left lower quadrant abdominal pain with associated alteration in bowel movements and 35 pound weight loss over 3 to 4 months. Routine blood work revealed a mild normocytic anemia. Colonoscopy revealed a large ulcerating 8cm x 5cm splenic flexure mass. Two days later, he presented to the emergency room with worsening left lower quadrant abdominal pain with passage of bloody mucus, but no flatus or stool. An abdominal x-ray showed dilated loops of colon in the right hemi-abdomen, but a sigmoid volvulus could not be ruled out. A CT scan revealed a complete bowel obstruction due to a very large descending colon intussusception with the splenic flexure mass serving as a lead point and a portion of the stomach invaginating inferiorly into this intussusception. He had emergency surgery with en bloc colon resection, diverting transverse colostomy, and long Hartmann's pouch. Final pathology revealed a T3 N0 lowgrade adenocarcinoma. Conclusion: Intussusception is rare in adults and is usually due to larger polyps or tumors. This case illustrates the need to pursue further imaging with CT when there are questionable abnormalities on plain abdominal x-ray. Abdominal CT is the most sensitive imaging exam for the diagnosis of intussusception and allows for the detection of a lead point.Figure: No Caption available.Figure: No Caption available.