Two days of severe crampy abdominal pain with blood diarrhoea. Generalised abdominal tenderness worse in the RIF. ?appendicitis.
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Bowel-in-bowel sign in the right lower quadrant with layering of bowel wall and mesenteric fat. There is intussusception of the ileum into the caecum extending through to the mid-transverse colon. At the apex, a tumour is suspected. Bowel wall is thickened (the intussuscipiens), but there are patchy hypodense areas particularly distally, concerning for vascular compromise. Proximal to this there is a short segment of dilated small bowel, measuring up to 3.5cm. The remaining colon is unremarkable. Perihepatic, mesenteric, right colic gutter and pelvic free fluid. No free gas. Within liver segment IVa/II is a 1.2cm hypodensity (25HU).
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The patient proceed to theatre and underwent a right hemicolectomy. Histopathology demonstrated a tubulovillous adenoma (low grade dysplasia) at the base of the caecum, adjacent to the ileocaecal valve, which is the lead point in this case.