Presentation
Constipation with vague palpable mass in right lumbar region.
Patient Data
There is telescoping of distal ascending colon into right third of transverse colon – representing intussusception. No intestinal obstruction.
There is heterogeneously enhancing plaque-like lesion as the lead point of intussusception measuring 1.7 cms in thickness and 3.6 cms in width, likely representing neoplastic lesion.
There are 3-4 prominent enhancing pericolic lymph nodes in the right lumbar region largest measuring 1.1 x 0.8 cms, suspicious for metastases. No necrosis.
There is severe atrophy of pancreatic parenchyma with visualization of minimal periductal parenchyma. Multiple intraductal calculi are noted in the head and uncinate process region largest measuring 9.4 x 4.0mm. No ductal dilatation. These features are consistent with chronic atrophic pancreatitis.
Patient underwent laparoscopic right hemicolectomy with extracorporeal anastomosis. Surgical specimen photograph shows resected right hemicolon with heterogeneous appearing mass lesion, which acted as the lead point for intussusception.
Case Discussion
Adult colo-colic intussusceptions are often due to an underlying lesion, which acts as lead point. Common lesions include lipoma and malignant neoplasms, like adenocarcinoma.
Our patient underwent laparoscopic right hemicolectomy with extracorporeal anastomosis. Intraoperatively, there was a heterogeneous intraluminal lesion in hepatic flexure which acted as lead point.
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