1044 Colo-Colic Intussusception with Large Bowel Obstruction in Adults

Abstract Background Intestinal intussusception in adults is rare and accounts for 1% of all bowel obstructions. Almost 90% of adult intussusceptions are caused by a pathological lead point like malignancy, polyp or a benign neoplasm. Colonic adenocarcinoma account for 60% of the cases, whereas colonic lipomas are the most common among benign pathologies. Case Presentation 60-year-old female presented with crampy abdominal pain and bloody diarrhoea with mucous discharge. On examination, she was tender in the left lower quadrant and had raised white cell count (WCC) and C-reactive protein (CRP). Computed Tomography (CT) scan reported colo-colic intussusception from proximal to mid sigmoid colon with early ischemic changes. Patient underwent a laparoscopic assisted en-bloc sigmoid resection with end colostomy. The patient had uneventful recovery. The histopathology showed benign lipoma with intussuscepted portion ischemic and necrosed. Discussion Intussusception is common presentation in children with bowel obstruction, often caused by enlarged lymphoid tissue and the treatment is usually conservative. However, in adults, it is a rare occurrence and presents with sub-acute abdominal pain and vague obstructive symptoms. CT scan is a useful investigation with diagnostic accuracy of 58-100%. The standard treatment involves surgery, with controversy about reduction of intussusception prior to surgery. Due to the risk of perforation and dissemination of malignancy, en-bloc resection is often recommended. Conclusions Colo-colic intussusception in adults is a rare presentation of acute bowel obstruction. A thorough history, appropriate investigations and timely intervention can ensure safe patient outcomes.