Ileocecal intussusception with cecal adenocarcinoma

Case contributed by Dr Fakhry Mahmoud Ebouda

Presentation

7 day history abdominal pain with a mass in the right upper quadrant seen on US

Patient Data

Age: 80 years
Gender: Male

No gas is seen in ascending and transverse colon.

Concentric alternating echogenic and hypoechoic bands are noted within the bowel, representing the characteristic target sign of intussusception, a.k.a. doughnut sign.

A sizable soft tissue lesion is seen within the right side of the abdomen. It extends up to the subhepatic space. It shows two concentric enhancing/hyperdense rings with focal fat at their center. The mesoappendicular vessels and fat are trapped within the intussuscipiens as well as the appendicular stump and ileocolic vessels. An associated mesoappendicular lymph node is seen.

The surrounding fat planes demonstrate stranding. Evidence of several sigmoid diverticula. A small right inguinal hernia is seen. Right hydrocele is also present.

The patient underwent a right hemicolectomy. Histopathology demonstrated a cecal adenocarcinoma, which was regarded as the lead point in this case. 

The appendix and bowel are seen invaginated through the intussusception. Cecal carcinoma noted as well.

Case Discussion

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

A proximal part of the bowel is pulled into the distal lumen and peristalsis pulls it forwards as if 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.

When intussusception occurs in adults, it is usually caused by a focal lesion acting as a lead point.

On ultrasound the characteristic target sign consists of concentric alternating echogenic and hypoechoic bands. The echogenic bands are formed by mucosa and muscularis, whereas the submucosa is responsible for the hypoechoic bands.

The case is courtesy of Dr Wael Farouk, general surgery consultant, RCMC.

 

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Case information

rID: 27423
Published: 2nd Feb 2014
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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