Ileocolic Intussusception - A rare cause of acute intestinal obstruction in adults; Case report and literature review

A 74 year old male presented with a four month history of colicky right upper quadrant pain, altered bowel habits and weight loss. He did not have any rectal bleeding. On examination there were signs of anaemia and a palpable mass in the right upper quadrant. Base line blood tests including FBC were normal. An abdominal USS showed a 5 × 7 cm ill defined bowel related mass in the right upper quadrant. The liver was normal.A subsequent barium enema showed an intra-luminal filling defect measuring 8 × 10 cm in the proximal transverse colon with no flow of barium proximally (Figure 1). CT scan of the abdomen showed significantly thickened bowel loops with fat density within a proximal segment and a target lesion, consistent with a neoplasm or a lipoma causing Intussusception (Figure 2).A provisional diagnosis of colonic carcinoma was made although the tumour markers including CEA and CA 19.9 were normal. The patient underwent a laparotomy where an ileocolic intussusception was found at the level of hepatic flexure (Figure 3). A right hemicolectomy was carried out with a hand sewn end to end ileocolic anastomosis. The specimen was opened to reveal a protruding polypoidal mass in the caecum (Figure 4). The patient made an uneventful post operative recovery and was discharged seven days later. The histology of the specimen showed this to be a benign submucosal lipoma of the caecum protruding into the caecal lumen.Intussusception is an uncommon cause of intestinal obstruction and more than 95% of cases occur in the paediatric age group [1]. Intussusception in adults is a rare pathology its incidence is around 2–3 per 1000,000 per year [2]. Due to this rare nature of the disease there are no large scale/multi-centre studies or meta-analyses published to investigate the management of adult intussusception. The aetiology, presentation and management of intussusception in adults is different from children. In children intussusception is usually idiopathic or secondary to a vira