University of Massachusetts Medical School Worcester, MA
Jason D. Yang, MD, PhD1, Matthew Petersile, MD2, John Levey, MD, MBA3; 1University of Massachusetts Medical School, Worcester, MA; 2UMass Memorial Medical Center, Worcester, MA; 3University of Massachusetts, Worcester, MA
Introduction: Intussusception rarely occurs in adults and is often due to adhesions, inflammation, benign lesions or malignancy. Classic symptoms that present in children such as currant jelly stools or palpable abdominal mass are absent in adults and thus diagnosis is reliant on abdominal imaging. The etiology of intussusception in adults should be investigated due to the concern for malignancy as a cause. We report a case of a patient with intussusception attributed to a dysplastic tubulovillous adenoma in the sigmoid colon found on colonoscopy.
Methods: A 61-year-old male with IBS presented for acute worsening of his chronic abdominal pain after eating breakfast. The pain was sharp and located in the left lower quadrant radiating to the epigastrium. He denied the pain changing with food and denied any diarrhea or infectious symptoms. He experienced a 15-pound weight loss in the past year. He had never undergone a colonoscopy. Initial lab workup was unrevealing with a normal complete metabolic panel and lipase. A CT of the abdomen was performed showing a short segment intussusception in the descending colon without obstruction. The patient underwent a colonoscopy which showed a non-obstructing mass in the sigmoid colon. Biopsies of the mass revealed tubulovillous adenoma with high-grade dysplasia. The patient was referred to colorectal surgery and underwent successful left hemicolectomy. Discussion: Colonic intussusception in adults can be due to benign polyps, inflammatory processes, adhesions, or malignancy, which comprises more than half of all adult cases. Malignant lesions may compress the walls of the intestine interfering with peristalsis and the point at which this occurs is known as the lead point. The altered peristalsis may lead to that segment of bowel invaginating into another, resulting in an intussusception. This causes obstruction which manifests as obstructive symptoms such as abdominal pain, constipation, nausea, and vomiting. Patients may also have a waxing and waning pattern of symptoms, as the intussusception may self-resolve and recur later. CT imaging may diagnose intussusception based on the presence of bowel invagination, however, the lead point is unlikely to be identified on CT imaging alone. Due to the high suspicion for malignancy acting as a pathologic lead point, adult patients presenting with colonic intussusception should undergo colonoscopy to investigate possible malignant causes of intussusception.
Figure 1. CT of the abdomen showing short segment intussusception in the descending colon (arrow).
Figure 2. Endoscopy image of a mass in the sigmoid colon.
Disclosures: Jason Yang indicated no relevant financial relationships. Matthew Petersile indicated no relevant financial relationships. John Levey indicated no relevant financial relationships.