Diagnostic challenge of the non-specific presentation of adult intussusception

Abstract

The following report will discuss the diagnosis and management of non-specific abdominal pain in a 77-year-old woman who presented to a district general hospital in South London. CT imaging demonstrated ileo-colic intussusception with free air and fluid indicating perforation. The images of the specimen clearly show the ileal tumour within the intussusception. Thus, the patient underwent an emergency right hemicolectomy and formation of a double-barrelled ileostomy. Histology subsequently confirmed this was secondary to a colonic adenocarcinoma. This case report is unique as it highlights that intussusception in adults is very difficult to accurately diagnose based on clinical features (due to non-specific findings) and even with radiology can be challenging. This is also the first documented case of the site of perforation not being directly involved with the site of intussusception. The perforation site was in fact distal to the intussusception. At the time of surgery, it was noted that the patient had significantly faecal loading up to her rectum. The resulting closed loop was the cause of her perforation.

Keywords: colon cancer; general surgery; radiology.

Figure 1

CT abdominal pelvis coronal image—colocolic intussusception (red arrow) with surrounding free fluid.

Figure 2

CT abdominal pelvis axial image—colocolic intussusception (red arrow) with surrounding free fluid.

Figure 3

CT abdominal pelvis sagittal image—colocolic intussusception (red arrow) with surrounding free fluid.

Figure 4

Intraoperative findings, intussusception perforated through transverse colon (held by haemostats) with necrosis.

Figure 5

Gross specimen—demonstrating colocolic intussusception into transverse colon.

Figure 6

Division of intussusception in longitudinal axis demonstrating the tumour.