Ileocaecal intussusception with caecal adenocarcinoma

Case contributed by Dr Fakhry Mahmoud Ebouda

Presentation

An eldery male complains of abdominal pain since 7 days and by US examination, mass is seen in the right abdominal quadrant.

Patient Data

Age: 80 years.
Gender: Male

No gas is seen in ascending and transverse colon.

Modality: Ultrasound

The appearances of intussusception in ultrasound is as a target sign, one of the appearance of intestinal intussusception, also known as the doughnut sign

The appearance is generated by concentric alternating echogenic and hypoechogenic bands. The echogenic bands are formed by mucosa and muscularis whereas the submucosa is responsible for the hypoechoic bands.

A sizable soft tissue lesion is seen within the right side of the abdomen. It extends up to subhepatic location. It shows two concentric enhancing / hyperdense rings with focal fat at its centre. The meso-appendicular vessels and fat as if trapped within the intussucepiens as well as the appendicular stump and ileocolic vessels. An associated mesoappednicular lymph node is seen.

The surrounding fat planes of smuggled strand appearance.Evidence of multiple sigmoid saccular outpouching are seen (diverticulae). Small right inguinal hernia is seen. Right hydrocoele is seen.

The appendix is seen invaginated through the intussusception.

Case Discussion

Intussusception occurs when one segment of bowel is pulled into itself (or a neighbouring loop of bowel) by peristalsis.

A proximal part of bowel is pulled into the distal lumen and peristalsed forwards as it were a bolus of food. The prolapsing part of the bowel is described as the intussusceptum while the distal segment of bowel receiving the intussusceptum is described as the intussuscipiens.  

Intussusception if occurs in the adult population,  it is usually caused by a focal lesion acting as a lead point.

The adjacent mucosa appears grossly oedematous. The appendix is identified invaginated with the ileum within the intussuscipiens. The appearances of the bowel involved suggest vascular compromise. No mucosal polyps or tumors are seen at the CT images.

The patient underwent a right hemicolectomy. Histopathology demonstrated a caecal adenocarcinoma which is regarded as a lead point in this case. 

The case is courtesy of Dr/ Wael Farouk, G. Surgery Consultant, RCMC

 

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Case Information

rID: 27423
Case created: 2nd Feb 2014
Last edited: 13th Mar 2016
Inclusion in quiz mode: Included

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