Colocolic intussusception secondary to colonic adenocarcinoma with impending caecal perforation in an elderly patient: A rare case report

Abstract

Introduction: Intussusception is a surgical emergency in which a part of the intestine slides into the distal adjacent part. Adult colocolic intussusception secondary to a tumoral process is a rare but serious clinical condition requiring immediate surgical intervention.

Case presentation: We report a case of a 65-year-old male patient presenting with abdominal pain and distention, subsequently diagnosed with colocolic intussusception in the descending colon with closed-loop bowel obstruction with impending caecal perforation. An exophytic mass on the descending colon was discovered intra-operatively, prompting a subtotal colectomy with ileosigmoidal anastomosis and loop ileostomy with the suspicion of malignancy. The histopathological examination of the surgical specimen concluded a moderately-differentiated colonic adenocarcinoma with 40% mucinous component.

Clinical discussion: Adult intestinal intussusception is a rare but serious condition differing greatly in etiology from its pediatric counterpart. Its preoperative diagnosis is challenging in adults, which appears to be due to its imprecise presenting signs and symptoms; thus, the condition can be mistaken for other causes of intestinal obstruction. Adenocarcinomas remain the most common cause of malignant tumors in the colon, which also makes them one of the causes for colocolic intussusception.

Conclusion: Intussusception can appear as a surgical emergency even in the elderly, necessitating prompt surgical intervention to avoid intestinal ischemia and gangrene. Its diagnosis can be aided to a great degree by CT imaging.

Keywords: Adult colocolic intussusception; Colon adenocarcinoma; Dilated caecum.

Fig. 1

Erect abdominal X-ray showing dilated large bowel loops and air fluid level.

Fig. 2

CT abdomen showing dilated caecum and telescoping of bowel segment into the descending colon.

Fig. 3

Subtotal colectomy specimen showing segment of ileum, ruptured caecum, appendix, ascending colon, transverse colon, and descending colon with colocolic intussusception.

Fig. 4

Cut section through the intussusception showing an exophytic friable mass in the descending colon, grey white to grey brown in color measuring 8.0 cm × 7.5 cm × 7.5 cm grossly involving up to muscularis propria. (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.)

Fig. 5

Section showing neoplastic tubular to cystic glands lined by pseudostratified columnar epithelium with loss of polarity and nuclear hyperchromasia. (a. H&E ×100, b. H&E ×400).