Cystic colon duplication causing intussusception in a 25-year-old man: report of a case and review of the literature

Abstract

Background: Colonic intussusception is a rare congenital abnormality, mostly manifesting before the age of two with abdominal pain and acute intestinal obstruction with or without bleeding. In adults it may occur idiopathically or due to an intraluminal tumor mass.

Case presentation: A 25-year-old man presented with an acute abdomen and severe crampy abdominal pain. The clinical picture mimicked acute appendicitis. Transabdominal ultrasound examination revealed a 5 cm circular mass in the right upper abdomen. The ensuing computed tomography suggested an intussusception in the ascending colon. Intraoperatively, no full thickness invagination was detected. Due to a hard, intraluminal tumor a standard right hemicolectomy with ileotransversostomy was performed. The histopathological analysis revealed a cystic colon duplication leading to mucosal invagination and obstruction.

Conclusions: In adults, colon intussusception is a rare event causing approximately 1% of all acute intestinal obstructions. Unlike its preferentially nonsurgical management in children, a bowel intussusception in adults should be operated because an organic, often malignant lesion is present in most cases.

Figure 1

Pre-operative imaging of the abdomen by ultrasound and computertomography. A) Transabdominal 5MHz Ultrasound examination revealing a 47 mm diameter round mass in the right upper abdominal quadrant (arrows). The computed tomography of the abdomen in an axial plane (B) with coronal reconstruction (C) showing the cystic duplication with mucosal invagination in the ascending colon. Notice the rectal contrast filling that stops at the lesion (arrows).

Figure 2

Macroscopical and histopathological findings of the specimen. A) The right hemicolon opened with the cystic duplication. B) The stool-filled cystic lesion is cut open. Notice the mucosal ulcerations (closed arrows). The open arrow depicts the ileo-ceacal area. C) Histopathological demonstration of the duplication cyst.