Appendiceal intussusception

Case contributed by Dr Matthew Daley

Presentation

Presented to hospital with five days of intermittent, colicky abdominal pain. Pain had settled at time of ED presentation and still passing flatus. Some anorexia but no vomiting, fevers or diarrhea. No previous abdominal surgery. bhCG negative.

Patient Data

Age: 30 years
Gender: Female
CT

There is a right ileocolic intussusception. There is significant telescoping of the ileum through the ascending colon. Both the ileum and the colon demonstrates significant wall thickening and edema. The apex of the intussusceptum is at the proximal transverse colon. There is mild pericolic edema but no collection, pneumatosis or perforation. There is fluid-filled distention at the apex of the ileum. No convincing lead point is identified but not excluded.

The small bowel proximal to this is not dilated.

The remainder of the large bowel is normal.

Case Discussion

Intussusception represents approximately 1-5 percent of all mechanical small bowel obstructions in adults; in over half of cases, a malignancy represents the cause of a pathological lead point. Surgical resection is often performed for this reason.

This patient underwent a laparoscopic-assisted right hemicolectomy. Pathology demonstrated a low-grade mucinous neoplasm without evidence of extra-appendiceal mucinous epithelium.

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Case information

rID: 65533
Published: 14th Jan 2019
Last edited: 27th Feb 2019
Inclusion in quiz mode: Included
Institution: Mater Hospital

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