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Chirurgia 2014 June;27(3):163-6


lingua: Inglese

Synchronous acute ileocaecocolonic intussusception and right colon volvulus associated with caecal adenocarcinoma and malrotation in an elder

Avgoustou C. 1, Papazoglou A. 1, Apessou D. 2, Papailiou J. 3

1 Second Surgical Department N. Ionia of General Hospital of “Constantopoulion – Aghia Olga”, Athens, Greece; 2 Pathologoanatomical Department Ionia of General Hospital of “Constantopoulion – Aghia Olga”, Athens, Greece; 3 Radiological Department Ionia of General Hospital of “Constantopoulion – Aghia Olga”, Athens, Greece


Ileocaecocolonic intussusception (ICCI) and right colon volvulus (RCV), in adults, are rare causes of bowel obstruction. An 88-year old woman with a 24-hour history of vomiting, abdominal pain, progressive abdominal distention and absolute constipation was emergently admitted. She was shocked and had a palpable right-to-centrum abdominal mass with widespread peritoneal rebound tenderness. Her history was unremarkable, except for cholecystectomy and chronic constipation. Blood tests showed leucocytosis and electrolyte deficit. Rectal examination revealed “currant jelly” stools. Abdominal X-ray demonstrated dilated small bowel loops and displaced right colon, and gasless colon in pelvis. Abdominal CT showed peritoneal fluid, air-distended bowel loops and mass catching up distal ileum, suggestive of obstructive ICCI. CT source images depicted torsion of the entangled in intussuscepted parts mesenteric vessels (“whirl sign”), reminiscent of RCV. Fluid resuscitation and IV antibiotics were administered. Patient underwent urgent laparotomy. ICCI extended up to upper ascending colon, with ischaemic segments, and twisting of unfixed right colon, along with distended bowel loops and free fluid, were found. There was no distal colonic obstruction. Right hemicolectomy and ileotransversostomy were performed. Postoperative courses were uneventful and the patient was discharged on Day 10. Histology confirmed presence of a 20-cm long ICCI associated with ischaemic changes of intussuscepting parts, mesenteric venous thrombosis, and caecal adenocarcinoma 5cm in diameter (pT3NO). Colonoscopy at 3 months was negative. Our patient, followed-up for 8 months, reported dramatic improvement in bowel function. The treatment for acute adult ICCI with RCV is emergent enblock resection of intestinal segments involved.

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