Adult Colocolic Intussusception and Literature Review
A 63-year-old Caucasian female with no significant past medical history presented with a 1-month history of intermittent right upper quadrant pain radiating to the umbilicus after 1 h of eating food. She also had decreased appetite, with an unintentional weight loss of 20 lbs within the past 6 months. In addition, she had had 1 year of nonbloody diarrhea with no history of travelling. She denied any chills, fevers, nausea or vomiting. Her surgical history included appendectomy, with no family history of colon cancer but significant for Crohn's disease.\nAt the time of presentation to the emergency room, her temperature was 98.1°F, blood pressure 175/83 mm Hg, pulse 76 beats per minute, respiratory rate 16 breaths per minute and oxygen saturation 99% while breathing ambient air. At abdominal examination she had appreciable bowel sounds with a right lower mild tender and palpable abdominal mass but no rebound tenderness. Laboratory test were within the normal range: blood cell count 8,800/µl, hemoglobin 9.5 g/dl and hematocrit 40.6% g/dl. However, she had an elevated CEA level of 78 µg/l with abdominal CT scan that showed considerable edema of the intussusception of the proximal colon into the mid-transverse colon, due to a tumor measuring 4.1 × 6.3 cm, with no obstruction. The small bowel loops were normal in caliber, but there was significant edema from the distal transverse colon almost to the splenic flexure (fig. ). Colonoscopy was performed to further evaluate the lead point of the intussusception, which was a tumor located at 65 cm in the transverse colon, causing partial obstruction. A biopsy was obtained at 60 cm, which showed colonic mucosa with focal erosion, congestion and focal hyperplastic changes.\nBased on these findings we diagnosed the patient with colocolic intussusception caused by colonic tumor. We performed an exploratory laparotomy that revealed an ascending 4.7 × 3.5 × 2.0 cm tumor as the lead point of intussusception into the proximal transverse colon, with palpable mesentery lymph nodes and no liver lesions (fig. ). The patient underwent right hemicolectomy with side-to-side ileocolic anastomosis. The postoperative course was uneventful, and she was discharged home after 6 days in good general condition. Histopathological examination of the tumor revealed high-grade mucinous adenocarcinoma with signet ring cells with 12 out of 12 lymph nodes negative for metastasis (fig. ). The final pathology staging was T3N0M0 or stage II.