Synchronous adenocarcinomas of the colon presenting as synchronous colocolic intussusceptions in an adult
© Chen et al.; licensee BioMed Central Ltd. 2012
Received: 11 December 2011
Accepted: 26 November 2012
Published: 15 December 2012
Intussusception is uncommon in adults. To our knowledge, synchronous colocolic intussusceptions have never been reported in the literature. Here we described the case of a 59-year-old female of synchronous colocolic intussusceptions presenting as acute abdomen that was diagnosed by CT preoperatively. Laparotomy with radical right hemicolectomy and sigmoidectomy was undertaken without reduction of the invagination due to a significant risk of associated malignancy. The final diagnosis was synchronous adenocarcinoma of proximal transverse colon and sigmoid colon without lymph nodes or distant metastasis. The patient had an uneventful recovery. The case also emphasizes the importance of thorough exploration during surgery for bowel invagination since synchronous events may occur.
Intussusception accounts for only 1 to 5% of intestinal obstructions in adults . Intussusception occurs most commonly in the small bowel, and colonic intussusception accounts for 15 to 27% of its occurrence [2–4]. Synchronous intussusception occurs even more rarely, and is only sporadically reported in the literature.
Adult intussusception represents only 5% of all cases of intussusception [5, 6]. Unlike children, more than 90% of all adult intussusceptions have pathological causes, especially colonic intussusception . Malignant intussusceptions account for the majority of colonic invaginations, whereas 80% of neoplasms associated with small bowel intussusception were benign . Primary colon adenocarcinoma is the most common underlying malignant lesion in colonic intussusception . Due to the high malignancy rate, en bloc resection without reduction for adult colonic intussusception is advocated to prevent any potential spread of the tumor and contamination of the abdominal cavity due to incidental perforation [8, 9]. Regarding benign tumors, lipoma is the most commonly pathologic lead point in both small and large bowel intussusception. The recognition of the tumor spectrum and incidence of malignances differ between small and large bowel intussusception in adults can help surgeons adopt appropriate surgical procedure for intussusception.
In contrast to pediatric presentation of acute intussusception, the classic triad of cramping abdominal pain, bloody diarrhea and a palpable tender mass is rare in adults . The symptoms of adult intussusception are non-specific . Abdominal pain is the most common presenting complaint, followed by nausea, vomiting, gastrointestinal bleeding and diarrhea . Morera Ocon, et al.  reported that the preoperative diagnosis of invagination was made in 25/30 (83%) of patients. However, in a review by Athanasios Marinis, et al. , the authors stated that variability in clinical presentation and imaging features often make the preoperative diagnosis of intussusception a challenging and difficult task. Reijene, et al.  reported a preoperative diagnostic rate of 50%, while Eisen, et al.  reported a lower rate of 40.7%.
Abdominal radiographs usually demonstrate signs of intestinal obstruction and may provide information about the site of the obstruction . Upper gastrointestinal contrast series or barium enema examination may demonstrate the characteristic appearance of a coiled-spring or cup-shaped filling defect . Ultrasonography is considered a useful tool for the diagnosis of intussusception by an experienced observer. The typical imaging features include the target or doughnut signs on the transverse view and the pseudo-kidney sign on the longitudinal view . With the growing use of CT in the diagnosis of abdominal diseases, especially for the patients presenting with acute abdomen, preoperative detection of intussusception has increased. Most studies also indicate that CT is the most accurate diagnostic tool for intussusception . Typical features of intussusception on CT s include the pseudo-kidney, target or bulls-eye sign, or the appearance of bowel-within-bowel configuration with or without fat and mesenteric vessels. The CT scan may also define the location, the nature of the mass, its relationship to surrounding tissues and additionally, it may help in disease staging in patients in whom malignancy is the suspected cause of the intussusception [13, 14].
To our knowledge, synchronous colocolic intussusceptions have never been reported in the literature. Here we describe the first case of synchronous colocolic intussusceptions caused by synchronous adenocarcinoma of the colon diagnosed preoperatively by CT. The case also emphasizes the importance of thorough exploration during surgery for bowel invagination, since synchronous events may occur.
Written informed consent was obtained from the patient for publication of this report and any accompanying images.
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