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Intussusception in an adult

Case contributed by Andrew Lawson

Presentation

Abdominal pain and possible mass in right upper quadrant on ultrasound.

Patient Data

Age: 78
Gender: Female
ct

Normal caliber large bowel can be traced up to the level of the hepatic flexure. At this point, the ascending colon and cecum are no longer confidently identified. The terminal ileum leads into a region of thick walled large bowel in the right upper quadrant which extends towards the midline. There is substantial regional bowel wall thickening with slight mural irregularity and enhancement visible on image 36 series 4. Multiple adjacent mesenteric lymph nodes are present ranging in size from 5- 15 mm. The proximal small bowel is only mildly distended. The liver, spleen and kidneys enhance homogeneously. The gallbladder is absent. 30 mm right mid pole renal cyst measuring. The pancreas and adrenals are unremarkable. No diverticular disease. The aorta is markedly calcified. Diffuse degenerative change throughout the lumbar spine and pelvis. The lung bases are clear. Surgical clips in the upper abdomen around the OG junction.

Conclusion: The differential diagnosis offered includes terminal ileum/cecal intussusception with no clear lead point identified or obstructed internal hernia. The appearances of the bowel involved suggest vascular compromise.

Case Discussion

Right hemicolectomy: A dilated right hemicolectomy with obvious intussusception, consisting of terminal ileum 50mm, cecum 70mm and ascending colon 250mm in length. The serosa of the cecum appears pale, however no tumor deposits are seen. Within the base of the cecum there is a large fungating and exophytic 70x55mm tumor, situated 40mm from the ileocecal valve. The adjacent mucosa appears grossly edematous. No appendix is identified. No other mucosal polyps or tumors are seen.

Biopsy report: cecal adenocarcinoma.

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