Bleeding Edge Therapy: Ileocolic Intussusception Due to Ileocecal Valve Adenocarcinoma and Its Management in an Adult Patient—Case Report and Literature Review

Zanni, Manuel; Vaccari, Samuele; Lauro, Augusto; Marino, Ignazio R.; Cervellera, Maurizio; D’Andrea, Vito; Tonini, Valeria

doi:10.1007/s10620-021-06849-y

Cited by 3 publications

(4 citation statements)

References 40 publications

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“…Ileocolic intussusception is characterized by the protrusion of the ileum into the ascending colon through the ileo-cecal valve. In ileocecal intussusception, the ileocecal valve serves as the lead point [ 6 , 12 , 13 ]. In this case report, we presented a rare glimpse of an ileocolic obstructing intussusception where a part of the terminal ileum telescoped into the cecum and ascending colon secondary to a cecal adenocarcinoma.…”

Section: Discussionmentioning

confidence: 99%

A Case of Long-Tract Ileocolic Intussusception Secondary to Well-Differentiated Cecal Adenocarcinoma

Ballan,

Aghababaei,

Chin

et al. 2024

Cureus

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Intussusception denotes the intricate phenomenon wherein one segment of the bowel undergoes invagination or telescoping into its contiguous distal segment. The ensuing invaginated segment may be propelled forward through peristaltic movements, potentially precipitating bowel obstruction or ischemia, culminating in necrosis of the affected bowel segment. Although the precise etiology of intussusception remains elusive, particularly in cases devoid of an identifiable lead point, dysrhythmic contractions and lymphoid hyperplasia have been implicated in the pathophysiology of this condition. We present the case of an 86-year-old African American female with a past medical history of hypertension and asthma who presented to our emergency room with a seven-day history of worsening abdominal. The pain was described as sharp and intermittent, and it would worsen with every meal or drink. A physical exam demonstrated the right lower quadrant with vague abdominal tenderness, especially below the umbilical region. Computed tomography of the abdomen and pelvis revealed a long segment of ileocolic obstructing intussusception in the ascending colon, with a 2.6 cm solid mass serving as a lead point. Swift intervention ensued with an urgent exploratory laparotomy, culminating in a right hemicolectomy to excise the intussuscepted segment of the bowel. The pathological examination identified a well-differentiated adenocarcinoma of the cecum, categorized as T1N0M0, with all 20 resected lymph nodes yielding negative results. This illustrative case presents a unique insight into a patient with ileocolic obstructing intussusception, caused by a well-differentiated adenocarcinoma acting as the lead point, a relatively uncommon occurrence in adults. Diagnosing intussusception in adults is challenging due to its nonspecific symptoms, which are similar to those of various other gastrointestinal disorders. Therefore, it is crucial for medical providers to be acutely aware of the possibility that adenocarcinoma can trigger obstructing intussusception in various parts of the bowel.

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Section: Discussionmentioning

confidence: 99%

A Case of Long-Tract Ileocolic Intussusception Secondary to Well-Differentiated Cecal Adenocarcinoma

Ballan,

Aghababaei,

Chin

et al. 2024

Cureus

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“…Intussusception is a rare entity in adults with an incidence of 2 to 3 cases per 1,000,000 people per year it represents 5% of all intussusceptions including those of pediatric age and from 1% to 5% of cases of intestinal obstruction. [1][2][3][4][5][6][7][8][9][10][11] Intussusception occurs when a segment of the gastrointestinal tract "intussusceptum" is introduced into the lumen of an adjacent segment of the digestive tract "intussuscipiens", generally follows the peristaltic direction (anterograde). 1,5,12 The result is partial or total obstruction and inflammatory changes ranging from thickening to ischemia and necrosis of the intestinal wall.…”

Section: Discussionmentioning

confidence: 99%

“…Therapeutic barium enema can be attempted in selected cases where the underlying pathology is known and the intussusception is colonic or ileocolic. 7,10,11 The signs that predict a surgical approach are the presence of intestinal occlusion, free fluid, pneumoperitoneum and intestinal pneumatosis. 22 Intussusceptions established as benign can be reduced without resection, , 3 However, if the bowel is inflamed or ischemic, reduction should not be attempted.…”

Section: Discussionmentioning

confidence: 99%

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Intussusception as an unusual etiology of intestinal obstruction in adults: case report and review

Campa¹,

Arias²,

Campa³

et al. 2023

Int J Res Med Sci

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Intussusception is a rare entity in adults, representing 1 to 5 percent of cases of intestinal obstruction. The clinical manifestations are non-specific, a structural lesion is identified by imaging, in more than 70% of the cases. Most cases require surgical treatment. We report the case of a 65-year-old female patient, with a history of intermittent colicky abdominal pain of two months of evolution, associated with nausea, vomiting, melena, and weight loss. Assessed in the emergency department due to worsening abdominal pain and lack of defecation. Her laboratory data reported anemia and leukocytosis. Abdominopelvic CT scan reported an image compatible with intussusception. We performed an emergency exploratory laparotomy, finding the terminal ileum invaginated into the colonic lumen., caused by a gastrointestinal stromal tumor. Intussusception in adults is uncommon but it should be considered as a diagnostic possibility in patients with intestinal obstruction, intestinal bleeding, and a palpable abdominal mass. Although these are non-specific manifestations, complementing the study with chemical and imaging analyzes significantly increases the diagnostic probability. The set of data obtained should be used to select the most appropriate treatment.

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Antegrade long giant ileocolic intussusception via colon–cecum cancer lead points: case report with focus on the sign of the python colon

Pierro,

Apollonio,

Mirco

et al. 2024

Egypt J Radiol Nucl Med

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Background Ileocolic intussusception is a rare condition that is difficult to diagnose. A pathological lead point, usually malignant, is often the cause of adult intussusception. In emergency scenarios, radiologists must be able to identify this entity and its causes and express their opinions on associated complications. Case presentation The hospital's emergency room admitted a 75-year-old woman who was suffering from intermittent abdominal pain and constipation. An abdominal contrast-enhanced computed tomography revealed a long giant ileocolic intussusception. Considering the clinical stability and the absence of signs of complications on CT, the patient did not undergo an urgent surgical procedure but underwent a colonoscopy the following day. Surprisingly, the colonoscopy highlighted the spontaneous resolution and revealed the presence of the three tumour lead points in the cecum and ascending colon. A CT was performed after the colonoscopy, confirming the intussusception's resolution. The surgeon performed a right oncological hemicolectomy. The malignant lead points on histological examination were moderate to poorly differentiated adenocarcinomas. Conclusions A giant and long ileocolic intussusception with a long embedded visceral segment (the python colon sign) could suggest pathological lead points in the cecum and ascending colon. Despite the large size, a spontaneous resolution of the python colon is possible. In this scenario, even if, on imaging, it is impossible to macroscopically identify a lead point, in cases of giant and long ileocolic intussusceptions, every effort must be undertaken to search for the cause of the intussusception.

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Bleeding Edge Therapy: Ileocolic Intussusception Due to Ileocecal Valve Adenocarcinoma and Its Management in an Adult Patient—Case Report and Literature Review

Cited by 3 publications

References 40 publications

A Case of Long-Tract Ileocolic Intussusception Secondary to Well-Differentiated Cecal Adenocarcinoma

A Case of Long-Tract Ileocolic Intussusception Secondary to Well-Differentiated Cecal Adenocarcinoma

Intussusception as an unusual etiology of intestinal obstruction in adults: case report and review

Antegrade long giant ileocolic intussusception via colon–cecum cancer lead points: case report with focus on the sign of the python colon

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