IDIOPATHIC ADULT COLO-COLIC INTUSSUSCEPTION

ABSTRACT ID : IRIA - 1181

• We present a 75 year old women who was referred to our radiology department with recurrent abdominal pain for past 3 months and mobile mass palpabe in right hypogastric region.

ABDOMINAL RADIOGRAPH ULTRASOUND

INTUSSUSCEPTION

The invagination or telescoping of a proximal segment of bowel (intussusceptum) into the lumen of a distal segment (intussuscipiens).

PATHOPHYSIOLOGY

• The invaginated segment is carried distally by peristalsis.

• Mesentery and blood vessels become involved with the intraluminal loop and are squeezed within the engulfing segment causing venous congestion.

TYPES

• Enteroenteric• Enterocolic• Colocolic

EPIDEMIOLOGY IN ADULTS

Rare in adults. Accounts for 0.003% to 0.02% of all

hospital admissions .• Accounts for 1% of all bowel obstructions in adults.• 80-90% of cases have an underlying cause .• 65% are due to neoplasm.• Location : Ileoileal > Ileocolic >Colocolic.

ETIOLOGY• Idiopathic (More common in children )

• Neoplasm

Benign ( More common in small bowel )

• Polyp, Leiomyoma, Lipoma, Lymphoma, Adenoma of

Appendix, Appendiceal stump granuloma

Malignant

• Primary ( More common in colon )

• Metastatic ( More common in small bowel )

ETIOLOGY

• Postoperative ( More common in small bowel)• Meckel’s diverticulum .• Colitis .• Many cases thought to be related to viral

gastroenteritis in children.

HISTORY AND PHYSICAL

Intermittent pain Nausea and vomiting Often red blood per

rectum Often nonspecific

complaints

Diffrential diagnosis :

• Intestinal

lipoma • Gallstone ileus

ABDOMINAL STUDIES Abdominal films often show signs of intestinal obstruction. Erect films often show fluid levels in

the small bowel.

Barium Studies

Show a classic “coiled spring” appearance due to trapping of contrast between layers of bowel.

ULTRASOUND

• Transverse scan shows a hypoechoic ring surrounding echogenic centre giving rise to “target sign / doughnut sign”

“Crescent in doughnut sign”

ULTRASOUND

Longitudinal scan shows bowel within bowel giving rise to “sandwich/pseudo-kidney sign”

C0MPUTED TOMOGRAPHY

• Target sign is also seen in CT.

• Can also see a sausage shaped mass

TREATMENT

• Adults require surgical exploration and resection of the intussuscepted bowel loops .

• Reduction is not recommended in adults due to the risk of spreading/seeding malignant cells, potential perforation of the intussuscepted bowel, and venous embolization at the ulcerated mucosa area .

CONCLUSION Idiopathic adult colocolic

intussusception is a rare but well-recognized condition. A high index of suspicion and early diagnosis with ultrasound and computed tomography scan will identify patients requiring emergency surgery and thus prevent serious complications such as haemorrhage , intestinal gangrene and perforation.

REFERENCES

1. TEXTBOOK OF RADIOLOGY AND IMAGING - DAVID SUTTON 2. DIAGNOSTIC RADIOLOGY - ARUN KUMAR

GUPTA 3. BEGOS DG, SANDOR A, MODLIN IM. THE DIAGNOSIS AND

MANAGEMENT OF ADULT INTUSSUSCEPTION. AMERICAN JOURNAL OF SURGERY 1997;173(FEBRUARY

(2)):88–94. 4. LOUKAS M, PELLERIN M, KIMBALLN Z, DE LA GARZA-

JORDAN J, TUBBS RS, JORDAN R. INTUSSUSCEPTION: AN ANATOMICAL PERSPECTIVE WITH REVIEW OF THE

LITERATURE. CLINICAL ANATOMY 2011;24(JANUARY):552–61. 5. MAYO CLINIC GASTROINTESTINAL IMAGING REVIEW -

C.DANIEL JOHNSON