Colocolonic intussusception

Case contributed by Dr Wayland Wang

Presentation

Recently noted anaemia, low iron, some constipation. Examination – normal PR exam but firm significant swelling over sigmoid area (LIF).

Patient Data

Age: 85
Gender: Female
CT

Concentric bowel wall soft tissue thickening over a 5.8 cm segment of the mid transverse colon is evident and is highly suspicious for colorectal carcinoma. Resultant short colo-colonic intussusception.

Several small adjacent nodules measuring up to 6 mm in diameter may reflect local metastases. No enlarged mesenteric lymph nodes identified.

A degree of fecal loading proximal to the lesion is noted with no evidence of gross bowel obstruction. No distended loops of bowel. Extensive sigmoid diverticular disease is demonstrated with no evidence of acute diverticulitis. No free fluid or free gas identified.

A 5 mm well defined low attenuation lesion within the left lobe of the liver is too small to accurately characterize but is likely to represent a small hepatic cyst. A tiny calcification within the right lobe of the liver is compatible with a small calcified granuloma.

Small nodules in the left anterior suprarenal location are of uncertain etiology and may reflect prominent lymph nodes. Multiple small cortical defects involving the kidney likely reflect previous small cortical infarcts. No hydronephrosis. The spleen, adrenals and pancreas are unremarkable.

The partially imaged lung bases are essentially clear.

Extensive degenerative disease of the lumbar spine is demonstrated including partial fusion of the L2 and L3 vertebral bodies. No suspicious osseous lesion identified.

CONCLUSION:

Concentric soft tissue thickening involving the mid transverse colon over 5.8 cm likely reflects colorectal carcinoma. Small adjacent noudules may reflect local metastases. No distant metastatic disease identified.

Case Discussion

Adenocarcinoma confirmed at surgery.

Small bowel intussusception is often transient without a pathological lead point. Colonic intussusception however should always be regarded with suspicion.

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Case information

rID: 59220
Published: 27th Mar 2018
Last edited: 9th Jan 2019
Inclusion in quiz mode: Included

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