IDIOPATHIC ADULT COLO- COLIC INTUSSUSCEPTION ABSTRACT ID : IRIA - 1181 IDIOPATHIC ADULT COLO- COLIC INTUSSUSCEPTION

We present a 75 year old women who was referred to our radiology department with recurrent abdominal pain for past 3 months and mobile mass palpabe in right hypogastric region.

ABDOMINAL RADIOGRAPH ULTRASOUND

INTUSSUSCEPTION The invagination or telescoping of a proximal segment of bowel (intussusceptum) into the lumen of a distal segment (intussuscipiens).

PATHOPHYSIOLOGY The invaginated segment is carried distally by peristalsis. Mesentery and blood vessels become involved with the intraluminal loop and are squeezed within the engulfing segment causing venous congestion.

TYPES Enteroenteric Enterocolic Colocolic

EPIDEMIOLOGY IN ADULTS Rare in adults. Accounts for 0.003% to 0.02% of all hospital admissions . Accounts for 1% of all bowel obstructions in adults. 80-90% of cases have an underlying cause . 65% are due to neoplasm. Location : Ileoileal > Ileocolic >Colocolic.

ETIOLOGY Idiopathic (More common in children ) Neoplasm Benign ( More common in small bowel ) Polyp, Leiomyoma, Lipoma, Lymphoma, Adenoma of Appendix, Appendiceal stump granuloma Malignant Primary ( More common in colon ) Metastatic ( More common in small bowel )

ETIOLOGY Postoperative ( More common in small bowel) Meckel’s diverticulum . Colitis . Many cases thought to be related to viral gastroenteritis in children.

HISTORY AND PHYSICAL Intermittent pain Nausea and vomiting Often red blood per rectum Often nonspecific complaints Diffrential diagnosis : Intestinal lipoma Gallstone ileus

ABDOMINAL STUDIES Abdominal films often show signs of intestinal obstruction. Erect films often show fluid levels in the small bowel.

Barium Studies Show a classic “coiled spring” appearance due to trapping of contrast between layers of bowel.

ULTRASOUND Transverse scan shows a hypoechoic ring surrounding echogenic centre giving rise to “target sign / doughnut sign” “Crescent in doughnut sign”

ULTRASOUND Longitudinal scan shows bowel within bowel giving rise to “sandwich/pseudo-kidney sign”

C0MPUTED TOMOGRAPHY Target sign is also seen in CT. Can also see a sausage shaped mass

TREATMENT Adults require surgical exploration and resection of the intussuscepted bowel loops . Reduction is not recommended in adults due to the risk of spreading/seeding malignant cells, potential perforation of the intussuscepted bowel, and venous embolization at the ulcerated mucosa area .

CONCLUSION Idiopathic adult colocolic intussusception is a rare but well-recognized condition. A high index of suspicion and early diagnosis with ultrasound and computed tomography scan will identify patients requiring emergency surgery and thus prevent serious complications such as haemorrhage , intestinal gangrene and perforation.

REFERENCES 2. DIAGNOSTIC RADIOLOGY - ARUN KUMAR GUPTA 1. TEXTBOOK OF RADIOLOGY AND IMAGING - DAVID SUTTON 2. DIAGNOSTIC RADIOLOGY - ARUN KUMAR GUPTA 3. BEGOS DG, SANDOR A, MODLIN IM. THE DIAGNOSIS AND MANAGEMENT OF ADULT INTUSSUSCEPTION. AMERICAN JOURNAL OF SURGERY 1997;173(FEBRUARY (2)):88–94. 4. LOUKAS M, PELLERIN M, KIMBALLN Z, DE LA GARZA-JORDAN J, TUBBS RS, JORDAN R. INTUSSUSCEPTION: AN ANATOMICAL PERSPECTIVE WITH REVIEW OF THE LITERATURE. CLINICAL ANATOMY 2011;24(JANUARY):552–61. 5. MAYO CLINIC GASTROINTESTINAL IMAGING REVIEW  - C.DANIEL JOHNSON