2069 Colocolonic Intussusception in a Patient With Ulcerative Colitis

Abstract

INTRODUCTION: Intussusception is common in children, but rare in adults accounting for 5-16% of all cases of intussusception. Giant pseudopolyps are polyps that measure more than 1.5 cm in diameter. These can function as lead points for intussusception in patients with inflammatory bowel disease (IBD). We present here an unusual case of intussusception due to a giant pseudopolyp in an adult patient with ulcerative colitis. There are only a limited number of case reports that describe this occurrence. CASE DESCRIPTION/METHODS: A 20-year-old man with a history of ulcerative colitis in remission on 5-ASA and 6-Mercaptupurine was found on surveillance colonoscopy to have a large inflammatory pseudopolyp resulting in partial obstruction. He was asymptomatic and physical examination was unremarkable. CT Abdomen/Pelvis showed transverse colon intussusception (Figure 1). He underwent a repeat colonoscopy with plan for endoscopic submucosal dissection of the large polyp. A 15 × 15 cm, frond-like/villous, broad based pseudopolyp without a stalk was seen in the proximal transverse colon (Figure 2a). Due to the large size of the polyp and inability to visualize the dissection plane, endoscopic submucosal dissection could not be performed. Debulking was achieved using piecemeal mucosal resection with a snare. A 15 × 15 cm area was resected and retrieved (Figure 2b). Histopathology showed fragmented pseudopolyp with ulceration, extensive granulation tissue and regenerative epithelial changes (Figure 3). He did well post procedure and was discharged home. He was advised to undergo colectomy but he remains undecided. He will undergo surveillance colonoscopy in 6 months. DISCUSSION: In adults, intussusception is a rare finding and most cases are due to colonic malignancy. Colocolonic intussusception secondary to giant pseudopolyps is an extremely rare occurrence in IBD patients. Presentation of these patients can vary from asymptomatic, abdominal pain, rectal bleeding, obstruction or intussusception. Although giant pseudopolyps do not have a malignancy risk, there has been one reported case of occult malignancy in a giant pseudopolyp. In addition, IBD patients at baseline are at an increased risk for malignancy. Asymptomatic patients can be managed medically. Successful endoscopic therapy with polypectomy has been reported in a few cases of giant pseudopolyps. Complications such as obstruction or intussusception require surgery. However, all of these patients will require frequent endoscopic surveillance.