Intussusception in an adult

Case contributed by Dr Andrew Lawson

Presentation

Abdominal pain and possible mass in right upper quadrant on ultrasound.

Patient Data

Age: 78
Gender: Female
CT

Normal calibre large bowel can be traced up to the level of the hepatic flexure. At this point, the ascending colon and caecum are no longer confidently identified. The terminal ileum leads into a region of thick walled large bowel in the right upper quadrant which extends towards the midline. There is substantial regional bowel wall thickening with slight mural irregularity and enhancement visible on image 36 series 4. Multiple adjacent mesenteric lymph nodes are present ranging in size from 5- 15 mm. The proximal small bowel is only mildly distended. The liver, spleen and kidneys enhance homogeneously. The gallbladder is absent. 30 mm right mid pole renal cyst measuring. The pancreas and adrenals are unremarkable. No diverticular disease. The aorta is markedly calcified. Diffuse degenerative change throughout the lumbar spine and pelvis. The lung bases are clear. Surgical clips in the upper abdomen around the OG junction.

Conclusion: The differential diagnosis offered includes terminal ileum/caecal intussusception with no clear lead point identified or obstructed internal hernia. The appearances of the bowel involved suggest vascular compromise.

Case Discussion

Right hemicolectomy: A dilated right hemicolectomy with obvious intussusception, consisting of terminal ileum 50mm, caecum 70mm and ascending colon 250mm in length. The serosa of the caecum appears pale, however no tumour deposits are seen. Within the base of the caecum there is a large fungating and exophytic 70x55mm tumour, situated 40mm from the ileocaecal valve. The adjacent mucosa appears grossly oedematous. No appendix is identified. No other mucosal polyps or tumours are seen.

Biopsy report: caecal adenocarcinoma.

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Case information

rID: 26103
Case created: 29th Nov 2013
Last edited: 2nd Oct 2015
Inclusion in quiz mode: Included

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