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Adult colonic intussusception: a case report
T Sasatomi1, T Oriishi, R Nakano
1Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan. sasatomi@med.kurume-u.ac.jp
Insights
Adult intussusception is rare, often caused by sigmoid colon cancer. This case highlights advanced sigmoid colon cancer leading to intussusception in an elderly patient.
Area of Science:
- Gastroenterology
- Surgical Oncology
Background:
- Intussusception is a common cause of intestinal obstruction in children but rare in adults.
- Adult intussusception often presents with non-specific symptoms and can be associated with underlying malignancy.
Observation:
- An 86-year-old female presented with rectal bleeding and symptoms suggestive of bowel obstruction.
- Initial colonoscopy identified sigmoid colon cancer; subsequent imaging revealed a characteristic concentric ring sign on ultrasonography and a cystic structure on CT.
- Contrast studies showed rectosigmoid colon stenosis, leading to surgical exploration.
Findings:
- Laparotomy confirmed sigmoid colon intussusception into the rectosigmoid colon.
- Resected specimen revealed advanced, well-differentiated adenocarcinoma of the sigmoid colon (4.5 cm x 2.0 cm) with ulceration and ischemic changes.
- Surgical management involved rectosigmoid and sigmoid colon resection.
Implications:
- This case underscores the importance of considering malignancy in adult intussusception.
- Early diagnosis and surgical intervention are crucial for managing intussusception caused by colon cancer.
- Highlights the diagnostic utility of combined imaging modalities in adult intussusception.
Abstract:
Intussusception accounts for almost all cases of intestinal obstruction in children. In contrast, intussusception in adults is relatively rare. An 86-year-old Japanese female with rectal bleeding came to our hospital via ambulance. At first, colonoscopy findings revealed the sigmoid colon cancer. Ultrasonography showed a hypoechoic mass with a multiple concentric ring sign. Computed tomography showed a round fluid-filled cystic structure. Colon contrast studies demonstrated stenosis in the rectosigmoid colon. A laparotomy was performed. The sigmoid colon was intussuscepted to the rectosigmoid colon. We employed both rectosigmoid and sigmoid colon resection. The resected specimen showed that the disease was advanced sigmoid colon cancer with ulcer formation due to an ischemic change. Tumor was 4.5 cm x 2.0 cm in size. The disease was histopathologically diagnosed as advanced sigmoid colon cancer, well-differentiated adenocarcinoma. We report here a case of adult intussusception due to the sigmoid colon cancer.