Retrograde colocolic intussusception induced by colonic adenocarcinoma
We used biopsy forceps for slow retraction (Figure B) and complete reduction (Figure C). The colonoscope was further inserted up to the cecum and no other lesions were found. A very large polyp was excised partially using a snare for the prevention of repeated intussusception and for histologic examination (Figure D). The pathology revealed adenocarcinoma and the patient underwent surgery. Recovery was uneventful and the patient was discharged 1 week later.
Figure B
Intussusception is defined as the invagination of a segment of the bowel and its mesentery into the adjacent bowel lumen. It is a common cause of intestinal obstruction in children, but rare in adults. Adult intussusception accounts for 5% of all causes of bowel obstruction and 5%-10% of all intussusception, and usually has a lead point.1 Retrograde colocolic intussusception is especially rare, with only 26 cases reported up to 2014.2 Altered peristalsis in focal areas of the bowel wall can lead to dysrhythmic contractions and cause retrograde intussusception.
Figure C
Adult colonic intussusception has atypical, nonspecific, intermittent, and vague symptoms and signs, resulting in a diagnostic challenge. Approximately one-half of patients present with symptoms of colonic obstruction with a duration of more than 1 month, as in our case. Many cases involve acute intestinal obstruction and are managed through emergency operation. Ultrasound imaging and computed tomography scans are the most sensitive and most commonly used preoperative diagnostic modalities. Colonoscopy is a useful tool for evaluating intussusception in colocolic intussusception,3 but there is no reported diagnosis of retrograde colocolic intussusception and reduction, as in this case.
Figure D
Treatment of adult intussusception is more frequently surgical compared with that in children, and leads to resection of the involved bowel segment without reduction before resection.3 In our case, intussusception was reduced easily with biopsy forceps under a direct colonoscopic view and was cured through elective laparoscopic left hemicolectomy after histologic proof was obtained.
References
1. Joseph T, Desai AL. Retrograde intussusception of sigmoid colon. J R Soc Med. 2004;7:127-8.
2.Baba M, Higaki N, Ishida M, et al. A case of retrograde intussusception due to semipedunculated polypiform adenocarcinoma in tubular adenoma of the sigmoid colon in an adult. Jpn J Gastroenterol Surg. 2001;34:282-6.
3. Kamble MA, Thawait AP, Kamble AT. Left side reverse colocolic intussusception secondary to malignant polypoidal growth: a rare clinical entity. Int Surg J. 2014;1:39-42.
