Ileocolic Intussusception Precipitated by Diagnostic Colonoscopy

Abstract

Only 5% of all cases of intussusceptions occur in adults. Intussusception complicating colonoscopy is an extremely rare event. Herein, we present a case of a 58-year-old man who developed ileocolic intussusception after a colonoscopy during which an adenomatous polyp was discovered in the terminal ileum. Eight hours after colonoscopy, the patient developed diffuse abdominal pain associated with vomiting and bloody diarrhea. A contrast-enhanced abdominal computed tomography scan revealed features of mechanical intestinal obstruction and a round soft tissue mass inside the right colon, followed by the wall of the intussusceptum. Emergency laparotomy revealed extended ileocecal intussusception with the polyp incarcerated by the ileocecal valve. A typical right hemicolectomy was performed, and the patient had an uneventful recovery. Histologic examination of the surgical specimen revealed an inflammatory fibroid polyp. Ileocolic intussusception due to an ileal polyp may be precipitated by colonoscopy and should be included in the differential diagnosis of acute abdomen after colonoscopy.

Intussusception after Routine Colonoscopy: A Rare Complication

“…In one such report, a large ileal polyp was identified but was not resected 6. In that patient, the endoscopic exam was largely normal, with just mildly congested mucosa noted throughout the entire colon.…”

“…Contrary to intussusception in the pediatric population, an identifiable etiology is found in 70–90% of cases 2,5. Causes include benign lesions, including adhesion, lipoma, polyp, harmatoma, as well as malignant lesions, including primary adenocarcinoma, gastrointestinal stroma tumor (GIST), and lymphoma 3,4,6. Because of this, most experts agree that after an intussusception is identified, the patient will likely require surgical resection.…”

Mysterious Cecal Polypoid Mass

“…Most often, preoperative diagnosis includes imaging studies, with computed tomography imaging being the most recently used, which show characteristic findings of 'target signs' enabling the radiologist to make a correct diagnosis (3). Occasionally, an intussusception may be confirmed by colonscopic evaluation; however, a recent report (4) documented that ileocecal intussusception due to an ileal polyp may be precipitated by colonoscopy and should be included in the differential diagnosis of acute abdomen after colonsoscopy. In adults, operative treatment is usually required because the cause often proves to be malignant.…”

Ileoileal Intussusception Secondary to an Ileal Fibroma

“…Onset of symptoms may be acute but may last for several weeks to a year before diagnosis [6]. Ileocolic intussusception due to an ileal polyp precipitated by colonoscopy has been reported [7]. Diagnostic workup with CT scan is useful with an accuracy of 80% [4, 8].…”