S1759 Early Post-Endoscopic Transverse Colo-Colonic Intussusception

Abstract

INTRODUCTION: Intussusception is a form of bowel obstruction defined as the telescoping of proximal segment of bowel into a distal segment. Intussusception in adults accounts for 5% of all cases and is usually secondary to a lead point such as a tumor or polyp. Intussusception in adults presents with vomiting, abdominal pain, hematochezia, or constipation. Cases where organic lesions act as the lead point present as a bowel obstruction. CT scan is diagnostic, which can identify location and presence of a lead point. Those with lead points can cause obstruction and ischemia- surgery is the treatment. Intussusception developing after an endoscopic procedure is extremely rare. In several cases there was a polypectomy performed and the subsequent intussusception was attributed to bowel edema acting as a lead point. All cases were treated with surgical intervention. CASE DESCRIPTION/METHODS: A 54-year-old female patient with a history of diabetes presented to the ED with worsening colicky abdominal pain starting four hours after a colonoscopy with polpectomy in the transvsere colon was performed. She also experienced red mucus in her stools. Her vital signs were within normal limits. On exam, she had a non-distended abdomen, with mild tenderness over the RUQ without any palpable masses. Her blood work was significant for a white count of 13 with a normal metabolic profile and lactate. The patient had an abdominal X- ray and CT of the abdomen which showed a transverse colo-colonic intussusception with partial obstruction. The patient was seen by the surgical team who opted for a conservative management with IV fluids and nil per os. Her symptoms rapidly improved the next day. She was started on a liquid diet which was advanced without complications. She was discharged on the third day after a normal bowel movement. An MRI two months after discharge was unremarkable. DISCUSSION: Intussusception with colonoscopy as an etiology is very uncommon. In our patient, polypectomy in the setting of colitis likely contributed to her development of an intussusception and partial bowel obstruction. There are no standard guidelines for management. In all colonoscopy-related cases cited, surgical interventions were pursued. Conservative management was pursued for our patient who had complete resolution of her symptoms. This report demonstrates that in non-malignant intussusception cases a conservative approach at first, with surgery reserved for patients with worsening symptoms, is practical.Figure 1.: Intussusception shown on abdominal CT (orange arrow).Figure 2.: Followup MRI showing resolution of intussusception (orange arrow).