Colocolonic intussusception in an adult secondary to an inflammatory polyp of the transverse colon - clinical case

Abstract

There are multiple causes of colocolonic intussusception in adults, such as tumors, autoimmune pathologies, previous abdominal surgeries, and gynecological conditions. Associated complications are small bowel obstruction, ischemia, necrosis, perforation with peritonitis, and sepsis that require urgent attention. A 78-year-old woman who started with colic in the mesogastrium of 5 months of evolution and changes in bowel habits. She went to the emergency room due to intense pain in the mesogastrium. On physical examination, she presented dehydration of the mucous membranes and pale integuments, pain on superficial and deep palpation in the mesogastrium. Admission laboratories: leukocytosis 17,110/ul, neutrophilia 67.9%, hydroelectrolyte imbalance: mild hyponatremia, mild hypochloremia, slightly prolonged coagulation times, normal blood chemistry. Abdominal ultrasound with "pseudokidney" image. Computed tomography reports an image of the introduction of a segment of the transverse colon into a contiguous segment of the same, with data of associated intestinal pneumatosis. Due to the previous findings, an emergency exploratory laparotomy was performed. Invagination of the transverse colon is located, accompanied by dilation of the vessels of the greater omentum; it is reduced manually, an enterotomy is performed and a tumor dependent on the wall is located, for which a 25 cm transverse colon resection, end colostomy and mucous fistula are decided. Pathology report reports inflammatory polyp. In the postoperative period, the patient improved and was discharged. Abdominal pain is the common presentation of intussusception; however, given its rarity in adults, the possibility of missing the finding on abdominal imaging leads to misdiagnosis.