Intussusception Due to Carcinoma of Colon

Abstract

Intussusception in adults from any cause is rare, and cases due to carcinoma of the colon seem to be extremely rare. A search of the literature of the past 10 years reveals only two cases associated with a carcinoma of the colon. Rose (1945) described a case of intussusception of the descending colon due to a polypus with a near-by, but apparently unrelated, carcinoma of the colon. lason (1945) On examination she was' seen to be a thin frail old lady with evidence of recent loss of weight. There was no abnormality detected on abdominal examination. Rectal examination revealed a typical sausage-shaped intussusception which had almost reached the anal orifice, and hence a diagnosis of chronic intussusception of the large bowel was made.Operation.-Spinal analgesia was used. The abdomen was opened by a lower midline incision. An intussusception of the pelvic colon into the rectum was found. Reduction was, from the first, difficult, but was partially achieved with the aid of an assistant exerting pressure on the apex through the anal orifice. An impasse was then reached, as no further reduction seemed possible. On increasing the reducing force, signs of splitting of the bowel appeared. and as no other means was possible the split was enlarged and complete reduction was achieved. It was now found that at the apex of the intussusception, in the middle portion of the pelvic colon, there was a small annular carcinoma. The split in the bowel was below this in the upper part of the rectum. The condition was further dealt with by excising the portion of the bowel containing the carcinoma and the split. Continuity could not be re-established and so the proximal end was brought out of the left inguinal region to form a permanent colostomy and the lower end was closed with two layers of sutures as in Hartmann's (1923) operation for removal of a carcinoma in the rectosigmoid region. The rest of the abdomen was not explored because of the danger of disseminating septic material. The wound was closed without drainage.Recovery was uneventful, and the patient was discharged on the 42nd post-operative day. The delay in her discharge was due to difficulty in obtaining a colostomy belt. The growth was reported as being a mucoid carcinoma. When last seen, almost exactly two years after operation, she was in good health and without any evidence of recurrence of the growth.Case 2 A man aged 68 was admitted with a history of two weeks' constipation, colicky abdominal pain, and the passage of blood per rectum.On examination he was seen to be a well-built man in fairly good general condition. Abdominal examination revealed considerable generalized distension and an increase in peristaltic sounds on auscultation. On rectal examination a typical intussusception with a papilliferous carcinomatous mass at the apex was found. It had reached as far as the lower part of the rectum. A diagnosis of chronic intussusception of the large bowel due to a papilliferous carcinoma was made.Operation.-Spinal analgesia was used, The abdomen was opened thro...

Sigmoidorectal Intussusception: A Report of Two Cases

“…Both the reported cases were treated by primary sigmoid colon resection without division of the inferior mesenteric artery and in both this seemed a perfectly adequate procedure for what appeared at operation, and was proven histologically, to be an early growth. The procedure is safe and simple in reasonably experienced hands, without the benefit of bowel preparation; a Hartmann operation leaving a terminal colostomy, or a Paul's operation (Owen, 1948) should neither be necessary and are certainly undesirable.…”