Presentation
Two days of severe crampy abdominal pain with blood diarrhea. Generalized abdominal tenderness worse in the RIF. ?appendicitis.
Patient Data
Bowel-in-bowel sign in the right lower quadrant with layering of bowel wall and mesenteric fat. There is intussusception of the ileum into the cecum extending through to the mid-transverse colon. At the apex, a tumor is suspected. Bowel wall is thickened (the intussuscipiens), but there are patchy hypodense areas particularly distally, concerning for vascular compromise. Proximal to this there is a short segment of dilated small bowel, measuring up to 3.5cm. The remaining colon is unremarkable. Perihepatic, mesenteric, right colic gutter and pelvic free fluid. No free gas. Within liver segment IVa/II is a 1.2cm hypodensity (25HU).
Case Discussion
The patient proceed to theater and underwent a right hemicolectomy. Histopathology demonstrated a tubulovillous adenoma (low grade dysplasia) at the base of the cecum, adjacent to the ileocecal valve, which is the lead point in this case.
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