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Adult intussusception—an elusive diagnosis

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Q1: The images show a characteristic mass lesion anteriorly. What diagnosis is suggested by these findings?

The findings are suggestive of intussusception. The images show a characteristic inhomogeneous soft tissue mass with fat stripes.1 When seen in longitudinal section, the mass may appear “sausage shaped” as in fig 1 (see questions; p 663). When seen in cross section, the concentric loops of intussuscepted bowel produce a “target” appearance, as in fig 2. This computed tomogram was consistent with an ileocolic intussusception.

Q2: How may this condition present in adults?

Intussusception in adults is unusual. An acute presentation is rare, more commonly the symptoms are insidious in onset and become chronic. The symptoms are variable and often non-specific. Abdominal pain is the most common symptom.2 Bowel obstruction is widely reported.3 Biliary obstruction4 and generalised peritonitis5 are also described.

Q3: How should such cases be managed?

The preferred management of adult intussusception is surgical. Many cases involve neoplastic lead points. Malignant disease is more common where the colon is involved. In this case, a 25 cm ileocolic intussusception was identified at laparotomy. The lead point was a caecal tubulovillous adenoma. It was treated with an extended right hemicolectomy. The patient made a rapid recovery thereafter and was discharged home 10 days after surgery.

Final diagnosis

Intussusception.

References

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