Adult colocolic intussusception and literature review

Abstract

Intussusception occurs when a proximal segment of the gastrointestinal tract, called intussusceptum, telescopes into the lumen of an adjacent segment, also known as intussuscipiens. Although common in early childhood, intussusceptions are very rare in the adult population. Most intussusceptions in adults are due to a lead point, which is an identifiable pathological abnormality, in opposition to children which there are no identifiable pathological lead points. In contrast to childhood intussusception, in adults it is associated with malignant lesions, particularly in the large bowel rather than in the small bowel. Its preoperative diagnosis and treatment in adults is difficult because of nonspecific abdominal symptom and because it rarely presents with the classic triad of vomiting, abdominal pain and passage of blood per rectum. We present a 63-year-old female with an adenocarcinoma tumor being the lead point in a colocolic intussusception, who was diagnosed preoperatively with computed tomography and had a colonoscopy to rule out obstruction. She underwent right hemicolectomy with side-to-side ileocolic anastomosis and did well postoperatively. In addition, we also review the literature and discuss the value of radiological modalities, location and surgical management to try to improve the preoperative diagnosis. Computed tomography scanning with intravenous contrast is maybe the most accurate modality for diagnosis of intussusceptions in adults, and treatment is usually surgical resection without reduction, since most of the colonic lesions are malignant.

Keywords: Adenocarcinoma; Adult; Adult colocolic intussusception; Colon; Computed tomography scanning; Intussusception; Literature review.

Fig. 1

Abdominal CT scan showing a heterogeneous soft tissue mass. a The ‘target sign’ seen with intussusceptions, which is then observed as the ‘sausage sign’ (b, c), as noted within the circular marking. There is radiolucent (dark) streak of fatty mesentery bordered by a sheath of hyperdense soft tissue of the bowel wall, as shown between the yellow arrowheads.

Fig. 2

Gross specimen of the ascending colon with the large arrow showing the tumor and the smaller arrows showing the palpable lymph nodes located in the mesentery.

Fig. 3

a H&E stain of the colon mass revealing invasion into the serosa. Original magnification ×40. b H&E stain of the colon segment demonstrating adenocarcinoma with presence of signet cells, as noted by the arrow. Original magnification ×400.