Adult obstructing ileocolic intussusception

Abstract

Background. We report a case of the adult obstructing ileocecal intussusception caused by carcinoma of the coecum.

Case report. A 44-year-old male patient has been admitted to the hospital with strong pain in the upper abdomen, vomiting and high amylase level in the blood serum 154 U/L (norm. 23-91 U/L at 37°C) and in the urine 792 U/L (0-400 U/L at 37°C). Sudden worsening of the patient's general condition on the 9th day after the admission associated with clinical and radiological signs of bowel obstruction were the reasons to perform emergency computerized tomography (CT) after days of clinical observation and follow-up with abdominal X-rays and ultrasound (US). CT revealed multiple concentric rings with centrally placed soft-tissue structure with higher attenuation on post-contrast scans, "target mass". Right haemicolectomy with terminolateral ileotransversoanastomosis without preoperative reduction was performed. Intraoperatively aboral loops of the ileum were found prolapsed into the coecum and ascendant colon with carcinoma of the coecum (Dukes B, Astler-Coller B2) acting as a neoplastic lead point for intussusception.

Conclusions. The adult intussusception may be a rare cause of abdominal pain but it must be on the differential diagnosis list in the case of intermittent abdominal pain, especially with clinical and radiological signs of the bowel obstruction. The reported case supports the opinion that CT is the imaging method of choice for the adult intussusception.