Intussusception in an adult
Abdominal pain and possible mass in right upper quadrant on ultrasound.
Loading Stack -
0 images remaining
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.
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.