Adult colonic intussusception: Surgery still the best option

Area of Science:

• Gastroenterology
• Surgical Oncology
• Radiology

Background:

• Intussusception, the telescoping of bowel, is common in children but rare in adults.
• In adults, intussusception frequently indicates an underlying malignant neoplasm, often a lead point tumor.
• Computed tomography (CT) is the preferred imaging modality for detecting lead points and localizing lesions.

Purpose of the Study:

• To present a case of adult intussusception secondary to colonic adenocarcinoma.
• To emphasize the diagnostic role of CT in identifying the intussusception and underlying pathology.
• To discuss the appropriate surgical management of malignant intussusception in adults.

Main Methods:

• Case report of a 79-year-old female presenting with symptoms of bowel obstruction.
• Diagnostic imaging using abdominal and pelvic computed tomography (CT).
• Surgical intervention via emergency laparotomy with histopathological analysis.

Main Results:

• CT revealed a rounded, heterogeneous density in the rectal lumen causing left-sided colonic obstruction.
• Emergency laparotomy identified a mid-sigmoid colonic mass intussuscepting into the rectum.
• Histopathology confirmed a T3N1 moderately differentiated colonic adenocarcinoma.

Conclusions:

• Adult intussusception warrants high suspicion for malignancy.
• CT is crucial for preoperative diagnosis and surgical planning.
• En bloc resection using oncologic principles is the recommended treatment to prevent complications like perforation and tumor spillage.