Mucinous tumor of transverse colon presenting with colo-colic intussusception in a 24-year old female: Aggressive tumor with a rare presentation in a young female

Abstract

Background: Intussusception is the most common cause of bowel obstruction in the children. However, it is rare in the adults, accounting for only 5% of all cases of bowel obstruction. In Adult Intussusception (AI), an underlying pathology can be demonstrated in majority of the cases. Malignancy is the most common cause of colonic intussusception. We present a case of colonic intussusception due to an underlying primary malignancy in a young female.

Colon Adenocarcinoma in a Retrograde Intussusception: A Case Report and Literature Review

“…[7] [9] [15] [16]. Although it has been reported that in these cases adenocarcinoma tends to be of early stages [8], it is more probable that intussusception is only related to tumor size, since larger tumors and/or with invasion to the mesentery or other organs prevent its development [8], and a tumor of small dimensions can present histological characteristics of high risk and even metastatic lymph node disease as in our patient.…”

“…Fifty-five percent of intussusceptions occur in the small bowel and when they develop due to a tumor, it is generally benign (submucosal lipoma, polyp, leiomyoma, angiolipoma) [ [20]; it has also been described that they can be caused by intestinal feeding tubes, since these can act as a guide point for their formation [12]. Approximately in 20% of the cases no underlying cause can be identified and it is called idiopathic [9].…”

“…[16], and may develop acutely, subacutely or chronically [2] [7] [9] [14] [17] [18] [19] [20]. Generally, entero-enteric intussusceptions have a more acute presentation compared to colonic intussusceptions which tend to develop subacutely or chronically [8].…”

“…The characteristic images of intussusception in CT scan are the "target bull's Open Journal of Gastroenterology eye" and the "sausage-shaped double-ring lesions" [2] [4] [5] [10] [13] [15]. This is the imaging study of choice for its diagnosis since it allows delimiting its location, recognizing its cause in up to 69% of the cases, and identifying data suggestive of ischemia and/or bowel perforation [3] [5] [9] [11] [15]; intussusceptions measuring more than 4 cm are unlikely to be resolved with conservative treatment [9]. Ultrasound has a diagnostic accuracy for intussusception of approximately 60% and can demonstrate a "doughnut sign" and "pseudo-kidney sign"; however, it can be limited by the distension of bowel loops and the patient's body habitus [10] [11] [12] [15].…”

“…There are no studies comparing conservative treatment with surgical treatment. While in pediatric patients intussusception can be reduced by enemas or even spontaneously with close monitoring [2] [3] [6] [9] [13] [15], in adults it usually requires early resection of the affected bowel segment especially if clinical or radiological data of bowel occlusion and/or an imminent complication are present since persistent proximal bowel distension due to distal occlusion may favor the development of microvascular ischemia and perforation culminating in peritonitis [1] [2] [5] [9] [13] [15]. In addition, the cause should be diagnosed and a malignant neoplasm should be discarded, for which surgery could also be therapeutic [1] [2] [7] [20].…”