Ileocolic Intussusception Secondary to Cecal Adenocarcinoma

Bleeding Edge Therapy: Ileocolic Intussusception Due to Ileocecal Valve Adenocarcinoma and Its Management in an Adult Patient—Case Report and Literature Review

“…Invaginations have been classified into four categories according to their location: enteroenteric, colo-colic, ileo-colic and ileo-cecal [8]. From a clinical perspective, the classic pediatric triad of abdominal pain, palpable abdominal mass and bloody stool is rarely seen among adults, since in most cases intussusceptions manifest with chronic intermittent cramping abdominal pain associated with nonspecific signs of bowel obstruction such as nausea, vomiting, constipation, or abdominal distention, with consequent delay of diagnosis [5,8,[15][16][17][18]. Preoperative diagnosis requires standard imaging: ultrasonography is considered a useful method with key findings including the "target" or "doughnut" signs in the transverse view and the "pseudo-kidney" or "hay-fork" sign in the longitudinal view.…”

“…Computed tomography is the most sensitive diagnostic method with imaging characterized by a "target" or "sausage shaped" soft mass with a layering effect [12,[19][20][21][22][23][24][25][26]. CT scans also define the extent of the occlusion, informing the clinician on the degree of surgical urgency and providing information regarding the existence of intestinal ischemia or perforation [16,22]. Colonoscopy is a resource to be considered in cases of CT-diagnosed colonic and colo-rectal intussusception, in order to obtain a preoperative diagnosis such as malignancy, that will guide the surgical approach.…”

“…Within the category "non operative surgery" there are also (a) the use of water-soluble contrast agent, an effective treatment for the adhesive small bowel obstruction [34], and (b) colonic stenting, performed as a bridge to surgery in patients with acute mechanical obstruction by providing preoperative decompression or as a palliation in those with advanced disease [35,36]. Laparotomy is required for the treatment of most cases among adult symptomatic intussusceptions since malignant lesions are present in a substantial proportion of patients [2,3,6,7,12,16,31,[37][38][39][40]. Intussusception associated with bowel obstruction frequently requires an urgent surgical solution; if there are signs of intestinal ischemia, a resection of the affected segment should be performed [17] although if there is absence of vascular impairment, the surgeon should try to reduce the invagination, then performing the selective resection of the causal element in order to avoid a larger intestinal resection.…”