Caecal intussusception: gross pathology
Long history of pain and LOW. Now presents with SBO.
Laparotomy for SBO with RIF mass.
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Extended right hemicolectomy 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.
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:
- a '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