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Cystic colon duplication causing intussusception in a 25-year-old man: report of a case and review of the literature.

Reiser-Erkan C, Erkan M, Ulbrich E, Nährig J, Kleeff J - BMC Surg (2010)

Bottom Line: A 25-year-old man presented with an acute abdomen and severe crampy abdominal pain.The clinical picture mimicked acute appendicitis.Intraoperatively, no full thickness invagination was detected.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of General Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.

ABSTRACT

Background: Colonic intussusception is a rare congenital abnormality, mostly manifesting before the age of two with abdominal pain and acute intestinal obstruction with or without bleeding. In adults it may occur idiopathically or due to an intraluminal tumor mass.

Case presentation: A 25-year-old man presented with an acute abdomen and severe crampy abdominal pain. The clinical picture mimicked acute appendicitis. Transabdominal ultrasound examination revealed a 5 cm circular mass in the right upper abdomen. The ensuing computed tomography suggested an intussusception in the ascending colon. Intraoperatively, no full thickness invagination was detected. Due to a hard, intraluminal tumor a standard right hemicolectomy with ileotransversostomy was performed. The histopathological analysis revealed a cystic colon duplication leading to mucosal invagination and obstruction.

Conclusions: In adults, colon intussusception is a rare event causing approximately 1% of all acute intestinal obstructions. Unlike its preferentially nonsurgical management in children, a bowel intussusception in adults should be operated because an organic, often malignant lesion is present in most cases.

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Pre-operative imaging of the abdomen by ultrasound and computertomography. A) Transabdominal 5MHz Ultrasound examination revealing a 47 mm diameter round mass in the right upper abdominal quadrant (arrows). The computed tomography of the abdomen in an axial plane (B) with coronal reconstruction (C) showing the cystic duplication with mucosal invagination in the ascending colon. Notice the rectal contrast filling that stops at the lesion (arrows).
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Figure 1: Pre-operative imaging of the abdomen by ultrasound and computertomography. A) Transabdominal 5MHz Ultrasound examination revealing a 47 mm diameter round mass in the right upper abdominal quadrant (arrows). The computed tomography of the abdomen in an axial plane (B) with coronal reconstruction (C) showing the cystic duplication with mucosal invagination in the ascending colon. Notice the rectal contrast filling that stops at the lesion (arrows).

Mentions: A 25-year-old man presented with an acute abdomen with abdominal defence and rebound in the right lower quadrant and with severe crampy abdominal pain. The patient reported of blood mixed stool within the last four days. There was no history or family history of inflammatory bowel disease. A transabdominal ultrasound examination revealed an unclear circular mass with 5 cm diameter in the right upper quadrant. The subsequent CT-scan showed an invagination of the ascending colon with rectal contrast enema passing no further (Figure 1); there was no critical extent of ceacal dilation evident on the CT-scan. No other intraabdominal pathology was detected.


Cystic colon duplication causing intussusception in a 25-year-old man: report of a case and review of the literature.

Reiser-Erkan C, Erkan M, Ulbrich E, Nährig J, Kleeff J - BMC Surg (2010)

Pre-operative imaging of the abdomen by ultrasound and computertomography. A) Transabdominal 5MHz Ultrasound examination revealing a 47 mm diameter round mass in the right upper abdominal quadrant (arrows). The computed tomography of the abdomen in an axial plane (B) with coronal reconstruction (C) showing the cystic duplication with mucosal invagination in the ascending colon. Notice the rectal contrast filling that stops at the lesion (arrows).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2909170&req=5

Figure 1: Pre-operative imaging of the abdomen by ultrasound and computertomography. A) Transabdominal 5MHz Ultrasound examination revealing a 47 mm diameter round mass in the right upper abdominal quadrant (arrows). The computed tomography of the abdomen in an axial plane (B) with coronal reconstruction (C) showing the cystic duplication with mucosal invagination in the ascending colon. Notice the rectal contrast filling that stops at the lesion (arrows).
Mentions: A 25-year-old man presented with an acute abdomen with abdominal defence and rebound in the right lower quadrant and with severe crampy abdominal pain. The patient reported of blood mixed stool within the last four days. There was no history or family history of inflammatory bowel disease. A transabdominal ultrasound examination revealed an unclear circular mass with 5 cm diameter in the right upper quadrant. The subsequent CT-scan showed an invagination of the ascending colon with rectal contrast enema passing no further (Figure 1); there was no critical extent of ceacal dilation evident on the CT-scan. No other intraabdominal pathology was detected.

Bottom Line: A 25-year-old man presented with an acute abdomen and severe crampy abdominal pain.The clinical picture mimicked acute appendicitis.Intraoperatively, no full thickness invagination was detected.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of General Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.

ABSTRACT

Background: Colonic intussusception is a rare congenital abnormality, mostly manifesting before the age of two with abdominal pain and acute intestinal obstruction with or without bleeding. In adults it may occur idiopathically or due to an intraluminal tumor mass.

Case presentation: A 25-year-old man presented with an acute abdomen and severe crampy abdominal pain. The clinical picture mimicked acute appendicitis. Transabdominal ultrasound examination revealed a 5 cm circular mass in the right upper abdomen. The ensuing computed tomography suggested an intussusception in the ascending colon. Intraoperatively, no full thickness invagination was detected. Due to a hard, intraluminal tumor a standard right hemicolectomy with ileotransversostomy was performed. The histopathological analysis revealed a cystic colon duplication leading to mucosal invagination and obstruction.

Conclusions: In adults, colon intussusception is a rare event causing approximately 1% of all acute intestinal obstructions. Unlike its preferentially nonsurgical management in children, a bowel intussusception in adults should be operated because an organic, often malignant lesion is present in most cases.

Show MeSH
Related in: MedlinePlus