Transient Descending Colo-Colonic Intussusception Due to a Large Fecaloma in an Adult: A Rare Case Report

Abstract

Introduction: Adult intussusception represents 5% of all cases of intussusception and accounts for only 1%-5% of intestinal obstructions in adults, and 0.003-0.02% of all hospital admissions. Transient nonobstructing intussusception is frequently idiopathic and resolves spontaneously without any specific treatment. We describe a case of transient non-obstructing colo-colonic intussusception due to a large fecaloma. Case Report: 53 years old African American lady presented to Emergency Department with severe progressive lower abdominal cramping pain of 12 hours' duration. Abdominal examination was significant for bilateral lower abdominal tenderness with hypoactive bowel sounds. CT scan of the abdomen and pelvis demonstrated a “colocolonic intussusception” in the descending colon extending over a length of 3.5 cm. Subsequently she underwent an emergent colonoscopy for possible reduction of the intussusception. On colonoscopy, in mid-descending colon, solid stool was found which was packing the entire lumen and it was deemed not safe to advance further so procedure was aborted. Patient was managed conservatively in the absence of peritoneal signs and underwent a water-soluble rectal enema next day that showed a filling defect in the mid descending colon. She was subsequently prepped for an elective colonoscopy for further evaluation of colonic mucosa. Colonoscopy demonstrated the presence of a large stool ball (fecaloma) in left colon even after colonic prep with polyethylene glycol. She was started on round the clock laxatives and she continued to have multiple bowel movements in hospital and her abdominal pain subsided.Figure 1Figure 2Figure 3Discussion: The incidence of intussusception is low in adults, particularly in the descending colon, due to the anatomical attachment of the descending colon to the retroperitoneum. Primary or idiopathic intussusception is usually transient while secondary intussusception due to a lead point is usually permanent or recurrent. In our patient, Intussusception was secondary to a fecaloma that served as a lead point but was transient. Abdominal computed tomography (CT) is currently considered as the most sensitive radiologic method to confirm intussusception. 70 to 90% of adult cases of intussusception require definitive treatment and often surgical resection is the treatment of choice. However, an isolated episode of transient non-obstructive intussusception can be managed conservatively.