Intussusception Secondary to Adenocarcinoma of the Colon

Abstract

Intussusception in adults is a rare occurrence, accounting for approximately 1%–3% of bowel obstruction cases. Here, we present a case of colocolic intussusception of the sigmoid colon caused by adenocarcinoma. A 67-year-old male presented to the emergency department with abdominal pain and rectal bleeding. A computed tomography (CT) scan revealed intussusception involving the sigmoid colon and a potential mass. In the operating room, the patient underwent flexible sigmoidoscopy, followed by sigmoidectomy and end colostomy. Pathological examination of the resected specimen confirmed moderately differentiated adenocarcinoma of the sigmoid colon with negative margins, and two of the 54 lymph nodes were positive for metastasis. A repeat CT scan of the abdomen showed multiple sub-centimeter low-density hepatic lesions, and biopsy confirmed a metastatic lesion. The patient ultimately elected hospice care. In this report, we describe a rare case of sigmoid intussusception in an adult patient, review the relevant literature, and summarize the diagnostic and management approaches suitable for adult intussusception cases.

Colon Adenocarcinoma in a Retrograde Intussusception: A Case Report and Literature Review

“…[10] [14] being the most frequent the first two [5]. Intussusceptions of the colon occur more frequently in its flexible segments, being in order of frequency the cecum, sigmoid and transverse colon [1] [9] [19]; in the latter accounts for 10% of the cases [16].…”

“…The characteristic images of intussusception in CT scan are the "target bull's Open Journal of Gastroenterology eye" and the "sausage-shaped double-ring lesions" [2] [4] [5] [10] [13] [15]. This is the imaging study of choice for its diagnosis since it allows delimiting its location, recognizing its cause in up to 69% of the cases, and identifying data suggestive of ischemia and/or bowel perforation [3] [5] [9] [11] [15]; intussusceptions measuring more than 4 cm are unlikely to be resolved with conservative treatment [9].…”

“…It predominates in pediatric patients; only 5% occur in adults in whom it causes 1% -5% of intestinal obstructions, 0.02% of hospital admissions, and 0.07% of abdominal surgeries [1] [3] [4] [5] [6] [7] [9] [10] [12]- [19]. Unlike infants, in adults 90% of intussusceptions are secondary to some pathology [1] [2] [14] [16] [17] whose probability of being a malignant disease is up to 65% in colonic and up to 30% in small bowel diseases [4] [10] [13] [14] [20], affects men and women equally [2], and its mean age of presentation is 63 years [8] [16].…”