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TWISTED FATE: COLON CANCER PRESENTING AS A CASE OF INTUSSUSCEPTION
Samee Farooqi
*1,2, Jocelyn Logan
2, Ahmad Mardini
11Advocate Christ Medical Center, Oak Lawn, IL; 2Methodist Hospital Southlake Campus, Merrillville, IN
Introduction:Intussusception occurs when a proximal segment of the intestine telescopes into a distal segment, leading to sudden abdominal pain. It is more common in children and rare in adults, accounting for only 1-5% of adult bowel obstructions, typically due to a pathological lead point like a mass. This case discusses a 59-year-old female patient with a previously undiagnosed colonic mass leading to intussusception.
Case Description:A 55-year-old female with a history of cerebral palsy presented with sudden, severe umbilical pain. Physical examination revealed a soft, tender abdomen with normal vital signs. Blood tests were unremarkable. Computed tomography (CT) abdomen pelvis showed distal transverse colon intussusception at the level of the splenic flexure, with high suspicion of a mass at the splenic flexure acting as the leading point. Patient was taken for emergent laparotomy with a probable diagnosis of transverse colon intussusception into the splenic flexure.
Intraoperatively, ileocolic and colo-colonic intussusception were found. The small bowel was not reduced laparoscopically to avoid damage, leading to conversion to an open procedure. The intussusception was visible, and after reduction, a large cecal mass was identified as the lead point. This mass had telescoped through the ascending and transverse colon, pulling the ileum and jejunum to the splenic flexure. The intussusception was reduced without signs of necrosis. The mass was sent for pathology, and a right hemicolectomy with ileocolonic anastomosis was performed. Pathology revealed a 5 centimeter well-differentiated adenocarcinoma arising from a tubulovillous adenoma, Stage IIA, with no lymph node involvement or indication for adjuvant chemotherapy.
Discussion:Intussusception primarily affects children, with 75% of cases being idiopathic. In adults, it usually results from a pathologic lead point, often malignant in 77% of cases. Symptoms include nonspecific obstructive signs like nausea, vomiting, and abdominal pain. While plain abdominal films can indicate obstruction, CT scans provide a definitive diagnosis, showing characteristic "target" or "sausage" signs. This case highlights a catastrophic complication of colon cancer and emphasizes the importance for colon cancer screening.
Preventative measures should prioritize colon cancer evaluation in adults, beginning at age 45. Recommended screening methods include high-sensitivity fecal tests, stool DNA tests, CT colonography, flexible sigmoidoscopy, colonoscopy and newly research blood-based DNA tests. For those who decline invasive methods, stool and blood DNA tests can serve as alternatives to increase patient compliance. Studies indicate that noninvasive screening tests were effective compared to no screening, underscoring the importance of timely screening for early detection and treatment.
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