Sigmoid colocolic intussusception
Acute onset abdominal pain, nausea, vomiting, constipation.
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Spiraling of sigmoid mesocolon with herniation of midsigmoid colon loop and mesentery into the distal sigmoid colon with a heterogeneously-enhancing poorly-defined mass lesion seen in the intussuscipiens. Surrounding four to five round sigmoid mesocolon enhancing subcentimetric lymph nodes seen. Loaded proximal entire large bowel with fecalization of contents in the terminal ileum. No features of bowel ischemia. Mesenteric vessels are patent. Incidental note of low density right adrenal nodule, most likely adenoma.
The most common site of intussusception is ileocolic and colocolic, typically identified in the pediatric population. It is rare in adults, especially unusual in the left colon. When it does happen, it is usually secondary to a bowel lipoma, neoplasm, or a nodal mass which acts as a lead point facilitating intussusception. Patients tend to present with severe abdominal pain and frank obstruction with bilious vomiting. In this case, a clinical mass was felt in the left iliac fossa and per rectal examination was negative. This needs immediate referral to a physician for reduction to prevent bowel ischemia, followed by a sigmoidoscopy for histopathological correlation.