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Mehmood F, Jamil H, Amin S, Fares J, Patel M. Colonic Intussusception Following Colonoscopy: A Case Report and Literature Review. GASTRO HEP ADVANCES 2025; 4:100612. [PMID: 40256314 PMCID: PMC12008563 DOI: 10.1016/j.gastha.2024.100612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2024] [Accepted: 12/31/2024] [Indexed: 04/22/2025]
Abstract
Intussusception following a colonoscopy is a rare complication, potentially triggered by biopsies or polypectomies. The most common symptoms include abdominal pain, nausea, vomiting, hematochezia, and fever. A computed tomography scan is the most sensitive diagnostic tool for detecting intussusception. While management is usually conservative, surgery may be required in rare instances. Only 13 cases of colo-colonic intussusception following colonoscopy have been reported, and among those, 4 needed a surgical intervention. We present a case of an elderly male who developed colo-colonic intussusception requiring a hemicolectomy after undergoing a colonoscopy with polypectomy.
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Affiliation(s)
- Faisal Mehmood
- Department of Gastroenterology, HonorHealth, Phoenix, Arizona
| | - Hajra Jamil
- Colon and Rectal Care Center of Phoenix, Phoenix, Arizona
| | - Shreya Amin
- Department of Gastroenterology, HonorHealth, Phoenix, Arizona
| | - Joseph Fares
- Department of Gastroenterology, HonorHealth, Phoenix, Arizona
| | - Mehul Patel
- Department of Gastroenterology, HonorHealth, Phoenix, Arizona
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2
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Tanioka N, Kuwahara M, Sakai T, Shimizu S, Kanazawa S, Mukaida K, Uka S, Takasaki M, Abe H, Munekage K, Akimori T. Retrograde Colonic Intussusception After Colonoscopy without Organic Pathology: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2024; 25:e945423. [PMID: 39396106 PMCID: PMC11480867 DOI: 10.12659/ajcr.945423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 09/05/2024] [Accepted: 08/29/2024] [Indexed: 10/14/2024]
Abstract
BACKGROUND Adult colonic intussusceptions are relatively rare and are mostly caused by organic structures that serve as lead points. However, the pathogenesis of adult intussusception is not fully understood, and no cases of retrograde colonic intussusception without pathological abnormalities or associations with colonoscopy have been reported. CASE REPORT A 74-year-old woman presented with abdominal distension and constipation. Abdominal computed tomography (CT) revealed marked dilatation of the right and sigmoid colon, initially suggesting volvulus of the sigmoid colon. Observation of the left colon revealed no abnormal findings on the colonoscopy. Due to the persistence of abdominal symptoms from right colon dilatation, another colonoscopy was performed, and a transanal drainage tube was inserted into the transverse colon. Enterography showed a steep contrast interruption in the descending colon, which was missed at this time. The patient's abdominal pain worsened 3 days after removal of the drainage tube. Retrograde intussusception of the sigmoid colon was discovered on abdominal CT, and a laparoscopic left hemicolectomy was performed. Pathological examination revealed multiple ulcers in the superimposed area, but no abnormal organic findings that could be considered as a lead point were found. In this case, the stretching technique and/or shear stress on the sigmoid colon by a second colonoscopy may have contributed to the development of this condition. CONCLUSIONS This is the first report of colonoscopy-associated retrograde colonic intussusception without organic abnormalities. Although much is unknown about the pathogenesis in this case, it may provide new insights into the pathogenesis of intussusception.
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Affiliation(s)
- Nobuhisa Tanioka
- Department of Surgery, Hata Kenmin Hospital, Sukumo, Kochi, Japan
| | - Michio Kuwahara
- Department of Surgery, Hata Kenmin Hospital, Sukumo, Kochi, Japan
| | - Takashi Sakai
- Department of Surgery, Hata Kenmin Hospital, Sukumo, Kochi, Japan
| | - Shigeto Shimizu
- Department of Surgery, Hata Kenmin Hospital, Sukumo, Kochi, Japan
| | - Shunsuke Kanazawa
- Department of Gastroenterology, Hata Kenmin Hospital, Sukumo, Kochi, Japan
| | - Kentaro Mukaida
- Department of Gastroenterology, Hata Kenmin Hospital, Sukumo, Kochi, Japan
| | - Shunsuke Uka
- Department of Gastroenterology, Hata Kenmin Hospital, Sukumo, Kochi, Japan
| | - Motoki Takasaki
- Department of Gastroenterology, Hata Kenmin Hospital, Sukumo, Kochi, Japan
| | - Hidekazu Abe
- Department of Gastroenterology, Hata Kenmin Hospital, Sukumo, Kochi, Japan
| | - Kensuke Munekage
- Department of Gastroenterology, Hata Kenmin Hospital, Sukumo, Kochi, Japan
| | - Toyokazu Akimori
- Department of Surgery, Hata Kenmin Hospital, Sukumo, Kochi, Japan
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Kim KH, Kim JS, Lee MS, Han HY, Kim JH. A Case of Colonic Intussusception with Post-polypectomy Electrocoagulation Syndrome and Review of Literature: How to Manage Intussusception Following Colonoscopy? THE KOREAN JOURNAL OF GASTROENTEROLOGY = TAEHAN SOHWAGI HAKHOE CHI 2024; 84:132-137. [PMID: 39319435 DOI: 10.4166/kjg.2024.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Revised: 09/10/2024] [Accepted: 09/16/2024] [Indexed: 09/26/2024]
Abstract
Colonic intussusception is often reported to be related to malignancy in adults. Colonoscopy itself with or without polypectomy is known to be a rare cause of colonic intussusception. We encountered a case in which an individual was diagnosed with intussusception following colonoscopy. The patient was a 44-year-old female who, on the same day, had undergone a colonoscopy including endoscopic mucosal resection for a polyp in the ascending colon. She visited the emergency room with complaints of right-sided abdominal pain. Abdominal examination revealed peritoneal irritation in the right upper quadrant. Abdominal CT revealed colocolic intussusception near the hepatic flexure. This was suspected to have been induced by post-polypectomy electrocoagulation syndrome. A laparoscopic right hemicolectomy was performed because conducting a reduction trial through colonoscopy involves a high risk of peritonitis, in addition to a low likelihood of spontaneous reduction of intussusception due to the additional edema and ischemia resulting from the polypectomy. The patient was discharged without complications six days after the surgery. Though some cases have been reported, there is no treatment strategy for intussusception following colonoscopy. Therefore, we report this case of colonic intussusception following colonoscopy, which was found to be caused by Post-polypectomy Electrocoagulation Syndrome, with a literature review.
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Affiliation(s)
- Kyung Hoe Kim
- Department of Surgery, Daejeon Eulji Medical Center, Eulji University, Daejeon, Korea
| | - Joo-Seok Kim
- Department of Internal Medicine, Daejeon Eulji Medical Center, Eulji University, Daejeon, Korea
| | - Moon-Soo Lee
- Department of Surgery, Daejeon Eulji Medical Center, Eulji University, Daejeon, Korea
| | - Hyun-Young Han
- Department of Radiology, Daejeon Eulji Medical Center, Eulji University, Daejeon, Korea
| | - Joo Heon Kim
- Department of Pathology, Daejeon Eulji Medical Center, Eulji University, Daejeon, Korea
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Xiang SH, Xu GQ. Colo-colonic intussusception as a rare complication of colonoscopy with polypectomy: Two case reports. World J Gastrointest Surg 2024; 16:1939-1947. [PMID: 38983333 PMCID: PMC11229999 DOI: 10.4240/wjgs.v16.i6.1939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/28/2024] [Accepted: 05/23/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Colonoscopy is the most frequently used diagnostic and therapeutic tool for the treatment of colorectal diseases. Although the complication rate is low, it can be potentially serious. Intussusception is a rare and severe complication often associated with polypectomy. Only a handful of post-colonoscopy intussusception cases have been reported, making this study a valuable addition to the medical literature. CASE SUMMARY Case 1: A 61-year-old man underwent colonoscopy with polypectomy for chronic abdominal pain. The patient experienced abdominal pain 11 hours later but was still discharged after pain management. He was readmitted due to recurring pain. Computed tomography (CT) showed colo-colonic intussusception. Initial conservative management and attempts at endoscopic reduction failed; therefore, laparoscopic right hemicolectomy was performed. Histopathological examination revealed tubular adenomas in the polyps and inflammation in the resected specimens. Case 2: A 59-year-old woman underwent colonoscopy with polypectomy for a polyp in the transverse colon. She experienced upper abdominal pain, fever, nausea, and vomiting 9 hours after the procedure. Emergency CT and blood tests revealed a colo-colonic intussusception near the hepatic flexure and an elevated white blood cell count. Initial attempts at endoscopic reduction failed and conservative treatment showed no improvement. She underwent successful laparoscopic reduction and recovered uneventfully. Histopathological examination of the resected polyp revealed hyperplasia. CONCLUSION Post-colonoscopy intussusception in adults is rare, and polypectomy may contribute to its occurrence. Early diagnosis is crucial, with prompt CT examination serving as key. After excluding malignancies, conservative management and reduction of intussusception should be considered before surgical bowel resection.
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Affiliation(s)
- Sai-Heng Xiang
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Guo-Qiang Xu
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
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Hashiguchi K, Mine S, Shiota J, Akashi T, Tabuchi M, Kitayama M, Matsushima K, Akazawa Y, Yamaguchi N, Nakao K. Colonic intussusception after endoscopic mucosal resection successfully managed by endoscopic procedure. Clin J Gastroenterol 2024; 17:466-471. [PMID: 38504057 DOI: 10.1007/s12328-024-01953-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 03/10/2024] [Indexed: 03/21/2024]
Abstract
Adult-onset intussusception, particularly associated with colonoscopy, is extremely rare. A 78-year-old man, referred to our hospital for colonic endoscopic mucosal resection (EMR), experienced subsequent dull abdominal pain, as well as elevated peripheral blood leukocytosis and C-reactive protein levels. Abdominal computed tomography (CT) revealed a colocolonic intussusception at the hepatic flexure. Emergency colonoscopy revealed ball-like swollen mucosa distal to the EMR site of the ascending colon. The mucosa was intact without necrosis. The endoscopic approach was able to temporarily release the intussusception. A transanal drainage tube was inserted through the endoscope to prevent relapse. Both CT and colonoscopy showed release of the intussusception. Our case underscores the importance of considering colocolonic intussusception in post-colonoscopy abdominal pain, advocating for endoscopic management after excluding mucosal necrosis.
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Affiliation(s)
- Keiichi Hashiguchi
- Department of Endoscopy, Nagasaki University Hospital, 1-7-1, Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan.
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
| | - Shoichiro Mine
- Department of Gastroenterology, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Junya Shiota
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Taro Akashi
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Maiko Tabuchi
- Department of Histology and Biomedical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Moto Kitayama
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kayoko Matsushima
- Medical Education Development Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Yuko Akazawa
- Department of Histology and Biomedical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Naoyuki Yamaguchi
- Department of Endoscopy, Nagasaki University Hospital, 1-7-1, Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan
| | - Kazuhiko Nakao
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Jastaniah A, AlBusaidi N, Bandegi P, Grushka J. Intussusception after colonoscopic polypectomy: a rare complication. BMJ Case Rep 2023; 16:e255048. [PMID: 37270178 PMCID: PMC10254697 DOI: 10.1136/bcr-2023-255048] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
We present a patient who developed an ileocolic intussusception within a few hours of undergoing an endoscopic polypectomy found on screening colonoscopy. She underwent a laparoscopic right hemicolectomy with intracorporeal anastomosis. Final histopathological examination showed no evidence of malignancy. Intussusception after colonoscopy is a rare complication, and only 11 cases have been reported prior to this case. Laparoscopic resection with intracorporeal anastomosis is a safe and feasible option in patients who are not candidates or failed conservative management.
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Affiliation(s)
- Atif Jastaniah
- Division of General Surgery, Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Nasra AlBusaidi
- Division of General Surgery, Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Pouya Bandegi
- Department of Diagnostic Radiology, McGill University, Montreal, Quebec, Canada
| | - Jeremy Grushka
- Division of General Surgery, Department of Surgery, McGill University, Montreal, Quebec, Canada
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7
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Vadakkenchery Varghese E, Steen C, Juszczyk K, An V. Splenic flexure intussusception: a rare complication post colonoscopy. ANZ J Surg 2021; 92:1545-1546. [PMID: 34694677 DOI: 10.1111/ans.17325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/12/2021] [Accepted: 10/16/2021] [Indexed: 11/27/2022]
Affiliation(s)
| | - Christopher Steen
- Department of Colorectal Surgery, Eastern Health, Box Hill, Victoria, Australia
| | - Karolina Juszczyk
- Department of Colorectal Surgery, Eastern Health, Box Hill, Victoria, Australia
| | - Vinna An
- Department of Colorectal Surgery, Eastern Health, Box Hill, Victoria, Australia.,Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
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Abstract
We present a 42-year-old woman who developed colo-colonic intussusception of the transverse colon near the hepatic flexure within a few hours after a routine colonoscopy. After conservative management with pain medication and hydration, her symptoms completely resolved within 24 hours. Colonic intussusception after a colonoscopy is rare, and the present case describes the most conservative approach leading to a complete resolution of symptoms.
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He H, Rambhujun V, DeMaria M, Ali M, Vrabie R. Early Postendoscopic Transverse Colo-Colonic Intussusception. Case Rep Gastroenterol 2020; 14:1-6. [PMID: 32009867 PMCID: PMC6984140 DOI: 10.1159/000505228] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 11/27/2019] [Indexed: 11/23/2022] Open
Abstract
Intussusception is defined as telescoping of the proximal bowel (intussusceptum) into the lumen of the distal bowel, otherwise called the intussuscipiens. While it is one of the most common causes of intestinal obstruction in children between the ages of 3 months and 6 years, intussusception accounts for about 1% of such cases in adults. Intussusception is idiopathic in 8–20% of patients and most commonly occurs in the small intestines in adults. We describe the unique case of a colo-colonic intussusception in a 54-year-old female patient 1 week after a colonoscopy for suspected inflammatory bowel disease. The discussion focuses on the presentation and management options of intussusception.
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Affiliation(s)
- Harry He
- Department of Medicine, NYU Winthrop University Hospital, Mineola, New York, USA
| | | | - Matthew DeMaria
- Department of Medicine, NYU Winthrop University Hospital, Mineola, New York, USA
| | - Mohammad Ali
- Gastroenterology and Hepatology, Guthrie Cortland Medical Center, Cortland, New York, USA
| | - Raluca Vrabie
- Department of Gastroenterology, NYU Winthrop University Hospital, Mineola, New York, USA
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Imasato M, Kim HM, Higashi S, Kajihara J, Hatano H, Demura K, Iiboshi Y, Ito T. Laparoscopic surgery for idiopathic adult intussusception successfully reduced by colonoscopy. JOURNAL OF THE ANUS RECTUM AND COLON 2019; 3:49-52. [PMID: 31559367 PMCID: PMC6752127 DOI: 10.23922/jarc.2018-021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 08/30/2018] [Indexed: 11/30/2022]
Abstract
Most cases of adult intussusception are caused by neoplastic lesions, and idiopathic adult intussusception is very rare. We present a case in which laparoscopic surgery was performed for idiopathic adult intussusception initially reduced by colonoscopy. A 53-year-old woman presented to the emergency department of our hospital with intermittent lower abdominal pain. Contrast-enhanced computed tomography and ultrasonography of the abdomen showed a concentric structure in the ascending colon. We diagnosed intussusception. Colonoscopy achieved successful reduction before surgery. Twelve days after this reduction, laparoscopic surgery was performed. Histopathological examination did not reveal any causative pathology; therefore, idiopathic adult intussusception was diagnosed. The postoperative course was uneventful, and the patient was discharged on postoperative day 14. Preoperative colonoscopy should be utilized to diagnose the main lesion and may be useful for reducing adult intussusception. Laparoscopic surgery is both minimally invasive and safe and can be performed following endoscopic reduction.
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Affiliation(s)
- Mitsunobu Imasato
- Department of Surgery, Rinku General Medical Center, Osaka, Japan.,Department of Surgery, Osaka Police Hospital, Osaka, Japan
| | - Ho Min Kim
- Department of Surgery, Rinku General Medical Center, Osaka, Japan
| | | | - Jun Kajihara
- Department of Surgery, Rinku General Medical Center, Osaka, Japan
| | - Hisanori Hatano
- Department of Surgery, Rinku General Medical Center, Osaka, Japan
| | - Koichi Demura
- Department of Surgery, Rinku General Medical Center, Osaka, Japan
| | - Yasuhiko Iiboshi
- Department of Surgery, Rinku General Medical Center, Osaka, Japan
| | - Toshikazu Ito
- Department of Surgery, Rinku General Medical Center, Osaka, Japan
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11
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Hassan WAW, Teoh W. Intussusception after Colonoscopy: A Case Report and Review of Literature. Clin Endosc 2018; 51:591-595. [PMID: 30300987 PMCID: PMC6283765 DOI: 10.5946/ce.2018.056] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 05/21/2018] [Indexed: 11/14/2022] Open
Abstract
Intussusception after colonoscopy is an unusual complication. A MEDLINE search revealed only 7 reported cases. We present a report of a 28-year-old man who developed abdominal pain several hours after routine colonoscopy and in whom computed tomography (CT) revealed colocolic intussusception. We postulate that this condition is iatrogenic and induced by suctioning of gas on withdrawal of the colonoscope. A common observation among the reported cases was abdominal pain several hours after colonoscopy and right-sided intussusception. All cases had colonoscopy reaching the right side of the colon. Treatment for adult intussusception remains controversial with regard to reduction versus resection, especially given the high association with a pathological cause and malignancy. Among the 8 reported cases, only the current case did not require surgery. A combination of benign colonoscopy, CT, and the clinical picture should provide sufficient information to initially choose a more conservative treatment approach.
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Affiliation(s)
- Wan Amir Wan Hassan
- Colorectal Surgery, Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - William Teoh
- Colorectal Surgery, Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
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12
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Abstract
We present a 31-year-old woman who developed ascending colon intussusception several hours after a routine colonoscopy where random mucosal biopsies were obtained. She underwent an ileocolic resection, and pathology did not show an etiology for the intussusception. Colonic intussusception occuring without pathology and after minimal intervention is rare.
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14
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Wang Y, Gowing S, Arena G. Adult colo-colonic intussusception caused by congenital bands: A case report and literature review. Int J Surg Case Rep 2016; 26:88-92. [PMID: 27475114 PMCID: PMC5010636 DOI: 10.1016/j.ijscr.2016.07.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 07/02/2016] [Accepted: 07/17/2016] [Indexed: 12/27/2022] Open
Abstract
Adult colo-colonic intussusception is predominantly associated with a pathologic lead point. First description of adult colo-colonic intussusception caused by congenital bands. Treatment typically involves en-bloc resection due to concern of malignancy. Laparoscopic techniques are safe, feasible, and may enhance recovery. Introduction Intussusception refers to the telescoping of a segment of bowel into the lumen of an adjacent segment. While pediatric intussusception is common and generally idiopathic, adult intussusception is exceedingly rare and is usually attributable to a pathologic lead point. Presentation of case 37-year-old man who presented with abdominal pain, and was preoperatively diagnosed with a colo-colonic intussusception. Intraoperatively, the lead point was found to be congenital bands, and there was no evidence of underlying malignancy. He underwent a laparoscopic-assisted extended right hemicolectomy with side-to-side ileo-colic anastomosis. Discussion Colo-colonic intussusception is a rare cause of intestinal obstruction in adults. Patients generally present with subacute abdominal pain and obstructive symptoms, rendering the clinical diagnosis challenging. Computed tomography has been shown to be the most accurate diagnostic imaging modality. Due to the high incidence of underlying malignancy in adult colo-colonic intussusception, en-bloc resection of the involved bowel segment remains the standard of care. Conclusion Congenital bands can serve as a lead point in colo-colonic intussusception, particularly in younger adults. Prompt surgical intervention remains paramount to limit morbidity.
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Affiliation(s)
- Yifan Wang
- Division of General Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Stephen Gowing
- Division of General Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Goffredo Arena
- Division of General Surgery, McGill University Health Centre, Montreal, Quebec, Canada.
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15
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Abstract
Intussusception is the telescoping of proximal bowel wall into the lumen of a distal segment. Whilst it is common in children, intussusception in adults is rare, and predominantly occurs secondary to an underlying malignant neoplasm. Abdominal and pelvic computed tomography (CT) is preferred for detection of lead points and lesion localisation. We present the case of a 79-year-old female with a four-day history of colicky abdominal pain followed by obstipation and distension. CT demonstrated a rounded heterogeneous density protruding into the upper rectal lumen, and also left-sided colonic obstruction. Emergency laparotomy revealed a mid-sigmoid colonic mass intussuscepting into the rectum. Histopathology confirmed a T3N1 moderately differentiated colonic adenocarcinoma. Given the high likelihood of underlying malignancy, surgical reduction of the intussusceptum may be complicated by perforation and tumour spillage. En bloc resection using oncologic surgical principles remains the first line treatment.
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Affiliation(s)
| | - S Loh
- University of Melbourne, Melbourne, Australia
| | - P Smart
- University of Melbourne, Melbourne, Australia
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16
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Sam JJ, Mustard R, Kandel G, Gardiner G, Ghaffar H, Kirpalani A, May G, Kim YI. Colonoscopy Leads to A Diagnosis of A Jejunal Gastrointestinal Stromal Tumour (GIST). Gastroenterology Res 2011; 4:277-282. [PMID: 27957028 PMCID: PMC5139866 DOI: 10.4021/gr380w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/08/2011] [Indexed: 11/08/2022] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors in the gastrointestinal (GI) tract, but are the least common of small intestinal malignant neoplasms. While GI bleeding is the most common clinical presentation of GISTs, intussusception and obstruction are uncommon, as GISTs rarely grow into the lumen. We describe an unusual case of a 50-year-old male who presented with intermittent obscure, overt GI bleeding requiring multiple hospital admissions and blood transfusions. His work-up included abdominal CT imaging, small bowel follow-through, gastroscopies, push enteroscopy, colonoscopies, and anterograde and retrograde double-balloon enteroscopies. Complicating his presentation were colonic angiodysplasias and the development of recurrent venous thromboembolism requiring anticoagulation. Within an hour after an apparently uncomplicated colonoscopy, he developed an acute abdomen secondary to a jejunal intussusception, which led to a laparoscopic small bowel resection and the diagnosis of a jejunal GIST. Given his GIST had no high-risk features, ongoing surveillance with abdominal CT imaging was arranged. This case illustrates the complex presentation and diagnostic difficulty of a jejunal GIST causing obscure, overt GI bleeding and this is the first reported case of a jejunal intussusception following colonoscopy. Due to its submucosal location, multiple endoscopic approaches had failed to diagnose the GIST prior to surgery.
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Affiliation(s)
- Justina J Sam
- Division of Gastroenterology, Department of Medicine, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Robert Mustard
- Division General Surgery, Department of Surgery, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Gabor Kandel
- Division of Gastroenterology, Department of Medicine, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Geoffrey Gardiner
- Department of Laboratory Medicine and Pathobiology, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Hasan Ghaffar
- Department of Laboratory Medicine and Pathobiology, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Anish Kirpalani
- Department of Medical Imaging, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Gary May
- Division of Gastroenterology, Department of Medicine, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Young-In Kim
- Division of Gastroenterology, Department of Medicine, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
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