Caecal intussusception: gross pathology

Case contributed by Dr Andrew Ryan

Presentation

Long history of pain and LOW. Now presents with SBO.

Patient Data

Age: 70
Gender: Female
Pathology

Laparotomy for SBO with RIF mass.

Extended right hemi-colectomy specimen

The transverse colon has been opened to show prolapsing caecum/ascending colon (this is described as the 'intussusceptum'). There is a necrotic mucosal lesion at the lead point of the prolapse (histologically benign). 

The second photo shows the inner aspect of the intussusceptum, with small bowel and probed appendix.

Case Discussion

This is the most pronounced intussusception I have seen and it therefore a good case to show the components and nomenclature of intussusceptions. 

There are two main prerequisites for intussusception:

  • 'lead point'; in this case it is a necrotic caecal mucosal mass, but it can be anything that the bowel can 'get hold of' and prolapse distally. Mucosal-based tumours (primary and secondary) are by far and away most common.
  • the proximal portion of bowel must be mobile; this is why small bowel is so commonly involved.   

The components of an intussusception are (using the above case as an example):

  • the inverted caecum/ascending colon is described as the ' intussusceptum'; this is the part of the bowel that is prolapsing. 
  • the transverse colon is the 'intussuscipiens'; the potion of the bowel receiving the intussusceptum.
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Case information

rID: 22086
Case created: 10th Mar 2013
Last edited: 10th Sep 2016
Tags: caecum, bowel
Inclusion in quiz mode: Excluded

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