Sigmoidorectal intussusception caused by colon carcinoma

Area of Science:

• Gastroenterology
• Surgical Oncology
• Abdominal Imaging

Background:

• Intussusception, the telescoping of one bowel segment into another, is uncommon in adults, typically resulting from obstruction.
• Malignancy is a recognized cause, but sigmoid colon cancer as the lead point for intussusception is exceptionally rare.
• Adult intussusception presents with nonspecific symptoms, complicating preoperative diagnosis.

Purpose of the Study:

• To report an extremely rare case of sigmoid colon intussusception caused by malignancy in an elderly patient.
• To discuss the diagnostic challenges and management of adult intussusception secondary to sigmoid colon cancer.
• To emphasize the importance of oncological resection in suspected cases of neoplasm-induced intussusception.

Main Methods:

• Case presentation of an 85-year-old female with bright red anal blood loss and a palpable rectal mass.
• Computed tomography (CT) scan revealing a 'target-sign' indicative of intussusception.
• Surgical intervention involving total mesorectal excision for suspected sigmoid colon malignancy.

Main Results:

• The patient presented with symptoms suggestive of lower gastrointestinal bleeding and a palpable rectal mass.
• CT imaging confirmed sigmoid colon intussusception into the rectum, measuring 15 cm, with a suspected neoplastic lead point.
• Successful oncological resection via total mesorectal excision was performed, leading to an uneventful recovery.

Conclusions:

• Sigmoid colon intussusception caused by malignancy is a rare clinical entity in adults, posing diagnostic difficulties.
• Prompt diagnosis and surgical management, including oncological resection, are crucial for favorable outcomes.
• This case underscores the need for high suspicion and appropriate imaging in elderly patients presenting with obstructive symptoms and rectal bleeding.