INTRODUCTION:
Intussusception in adults is an infrequent cause of intestinal occlusion that is usually due to
neoplasm lesions. The unspecific nature of the clinical presentation often delays diagnosis. It is most commonly emergency explorative
laparotomy which clarifies the etiology of the occlusion. The authors report a case of intestinal occlusion caused by ileocecal-colonic invagination with a small cecal
adenocarcinoma as lead point, in a 74-year-old woman. CASE REPORT: A 74-year-old woman came to the Emergency Department, complaining of crampy
pain in the mid- and lower abdomen. An abdominal ultrasound revealed a "pseudokidney sign" apparently involving the cecum. Because there were no clear signs of occlusion, the patient was dicharged on the same day. Three days later, upon admission, the patient complained of episodes of
abdominal pain with intervals of moderate well-being, associated with
nausea,
vomiting and an inability to pass stool (but not gas) for 36 hours. On clinical examination her abdomen was distended and tender on palpation in all quadrants, especially in the right iliac fossa where a large mass could be felt. Standard abdominal x-Ray documented gaseous distension of some loops of the jejunum-ileum with some air-fluid level. The patient underwent an abdominal CT scan which showed advanced
intussusception that appeared to be ileocolic and multiple enlarged lymphnodes were found in the invaginated mesentery at the base of which there appears to be a thickening of the intestinal wall that is probably neoplastic in nature. The patient underwent explorative
laparotomy. Ileocecal-colonic
intussusception caused by a cecal growth 5 cm in diameter was found on examination of the surgical specimen. Histology showed that the cause of the large swelling of the ascending colon was a vegetating ulcerated
adenocarcinoma (medium grade differentiation: G2), measuring 6.5x 4.0 cm, arising from a tubulovillous
adenoma infiltrating the submucosa. CONCLUSIONS: Most cases of
intussusception are caused by structural lesions, a large percentage of which are malignant, especially in the colon. In our patient the lead point was a small cecal
polyp which, together with the last loop of the ileum and the ileocecal valve, was pulled into the ascending colon. Although most cases of
intussusception in adults are diagnosed at the
operating table, noninvasive diagnostic tools like ultrasonography and CT scanning are very useful. Treatment in adults is usually surgical and involves en bloc resection of the lesion. Manual reduction of the
intussusception is not advisable because of the risk of dissemination if the lead point is malignant. KEY WORDS: Cecal
adenocarcinoma, Itestinal resection,
Intussusception in adults.