Symptomatic appendiceal intussusception-rare pitfall of the historical inversion technique

Abstract

Appendiceal intussusception is a rare condition with an unknown incidence of clinical presentation, and an estimated incidence of 0.01% is based on a histological study only. It presents a diagnostic challenge with lack of standardized management strategies, and its description in literature is limited to case reports and series. Clinical presentation is often variable and nonspecific; it is uncommon to have a definitive preoperative diagnosis. Iatrogenic appendiceal intussusception can occur as a result of the historical simple inversion or inversion-ligation appendicectomy technique, but it is seldom reported to cause symptoms. We present a case of symptomatic appendiceal intussusception diagnosed preoperatively on both computed tomography and colonoscopy prior to proceeding with elective definitive surgery in a patient with no reported prior history of appendicectomy.

Keywords: appendiceal intussusception; appendiceal inversion; inversion-ligation technique; partial caecectomy.

Figure 1

Coronal (A) and axial (B) views of CT scan demonstrating tubular rim enhancing structure in the caecal lumen with surrounding fluid, suspicious for invaginated appendix, which was otherwise not identified.

Figure 2

Colonoscopy image demonstrating a visible invaginated appendix within the caecal pole, with no other mucosal lesions or abnormalities seen.

Figure 3

Intraoperative image of caecum with no visible appendix and suture material at the base (A), and partial caecetomy specimen showing an invaginated intact appendix (B).