Ileocolorectal intussusception due to tubulovillous adenoma
Three days of abdominal pain and distension. On examination, firm swelling left side of abdomen.
CT abdomen and pelvis
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There is a long intussusception involving distal small bowel and the entire colon down to the rectum. The mesenteric vessels within the intussusception are distended. The small bowel not involved in the intussusception is distended and fluid filled in keeping with obstruction. Incidental finding of multiple small cysts in the liver.
When an intussusception is found in adults, in contradistinction to children, a neoplastic lead point should be considered. This may be benign or malignant. Laparotomy was performed to reduce the intussusception and a tubulovillous adenoma found at the lead point.
Macroscopic: 300 mm of the large bowel and a further 300 mm of bowel intussuscepted through it. At the tip of the intussusception, there is a slightly raised, velvety lesion 35 mm in diameter.
Microscopic: The lesion identified at the tip of the intussusception is a tubulovillous adenoma showing low-grade epithelial dysplasia. There is no evidence of high-grade dysplasia or malignancy. Background bowel is normal. There is no abnormality of the mesentery.