EDITOR'S QUIZ: GI SNAPSHOT

Answer

From question on page 541

Computed tomography (CT) scan showed invagination of a segment of thickened terminal ileum into the ascending colon at the level of the hepatic flexure. The leading point of the intussusceptum revealed marked mucosal irregularity and created a convex margin as it met air in the distended ascending colon. Laparotomy was performed and revealed an 8 cm bowel mass with telescoping of the terminal ileum to the ascending colon. Right hemicolectomy without reduction of intussusception and primary anastomosis was performed. The operative specimen demonstrated the leading point of the intussusception as a circumferential ulcerative caecal tumour (fig 2). The patient recovered well and was discharged eight days after operation. Pathology revealed Dukes' C moderately differentiated adenocarcinoma.

Figure 2 Operative specimen demonstrated the leading point of the intussusception as a circumferential ulcerative caecal tumour.

Enteric intussusception is an uncommon condition in adults. It represents 1% of patients with bowel obstructions. In contrast with intussusception in children, a demonstrable aetiology is found in 70–90% of cases, of which at least half are due to malignancy. The lesion disturbs peristalsis of the bowel and causes telescoping of the proximal segment into the distal bowel lumen. Unlike the acute presentation in children, adult intussusception may present with acute, intermittent, or chronic symptoms. Abdominal pain is the most common presentation. CT usually shows the intussusception complex well. Other investigations may include ultrasound, contrast study, or colonoscopy. Treatment requires resection of the involved segment of bowel with its draining lymphatic due to the high likelihood of an underlying malignancy. Reduction should be avoided as the bowel wall involved is usually oedematous and friable. Manipulation increases the risk of bowel perforation, contamination, and possible cancer spillage.