Adult Intussusception Caused by Descending Colon Cancer during Chemotherapy of Stomach Cancer Recurrence

Abstract

Intussusception in adults is uncommon, and it is rare in the descending colon because of its fixation to the retroperitoneum. We herein describe a case of intussusception caused by descending colon cancer. A 74-year-old man was admitted to our hospital for treatment of vomiting and abdominal pain. He had undergone chemotherapy for lymph node recurrence of stomach cancer for about 4 years. Computed tomography revealed a ‘target mass’ with a tumor in the descending colon. We diagnosed his illness as intussusception of a descending colon tumor and performed emergency laparotomy. Conservative resection was performed following anastomosis after reduction of the intussusception. The tumor was pathologically diagnosed as poorly differentiated adenocarcinoma with neuroendocrine features. To the best of our knowledge, this is the first report of an intussusception caused by descending colon cancer incidentally diagnosed during chemotherapy for stomach cancer recurrence.

Rare occurrence of colonic cancer intussusception

“…The ability of the proximal colon and associated mesentery to telescope into the distal portion of the colon from a lead point usually occurs in sections of the intestine that is mobile such as small bowel, caecum, transverse and sigmoid colon. 5 Similar to a previously reported case, 6 patient 2 had a redundant sigmoid and descending colon, allowing the mechanics of proximal colon telescoping into the distal portion caused by the small colon adenocarcinoma as the lead point. The traditional dogma with colonic cancer intussusception is to avoid reducing the colon, to avoid any intraoperative complications such as perforation and cancer dissemination.…”

“…There is a paucity of data on colorectal cancer intussusception, with only two small case series 3,4 and a handful of case reports identified in our search. 5,6 These patients can present with nonspecific symptoms including abdominal pain, haematochezia, change in bowel habits and obstructive symptoms. 3 However, it is also important to recognize asymptomatic intussusceptions.…”

Colonic intussusception masquerading as diverticulitis: a case report of a 31 year old diagnosed with colorectal carcinoma after multiple presentations to the ED for episodes of acute diverticulitis

“…Colonoscopy is an appropriate tool for evaluation of intussusception, especially when there is concern for large bowel obstruction because it allows for the lesion to be diagnosed and biopsied. Although colonic intussusception is rare finding in general, descending colonic intussusception of the descending colon is even more uncommon because of its fixation to the retroperitoneum, with only a few cases reported in the literature [ 9 ]. Colonic intussusception is more likely to occur in the mobile portions of the colon such as in the cecum or sigmoid colon.…”

“…In pediatric cases, it is appropriate to attempt to reduce the intussusception using barium enema. In adults, however, this approach is not advised due to the concern for malignancy [ 9 ]. Surgery is the primary management in adults with intussusception produced by an underlying lead point.…”

Descending colo-colonic intussusception secondary to signet ring cell carcinoma: A case report

“…Colo-colonic intussusceptions are often located in the sigmoid colon or cecum ( 11 ). Intussusceptions of the descending colon are more uncommon due to the anatomical attachment of the descending colon to the retroperitoneum ( 12 ).…”