Colocolic Intussusception Due to an Inflammatory Fibroid Polyp Managed Laparoscopically: A Rare Case Report.

Manash Ranjan Sahoo, MS, Anil Kumar T, POST, GRADUATE


INTRODUCTION: Intussusception is the invagination of one segment of the intestine into another.It is common in children but rare in adults. Only 5% to 10% of intussusceptions occur in adults. It is of 4 types- enteroenteric, ileocolic, ileocaecal, colocolic. Colocolic intussusceptions is the rarest form. Colocolic intussusceptions in adults is mainly caused due to a malignant lesion. It is very rarely due to a benign cause. Intussusceptions in adults can be further classified on the basis of whether there is a lead point or not. Intussusceptions without a lead point are usually transient. An inflammatory fibroid polyp is an uncommon polypoidal lesion of the gastrointestinal tract. It commonly occurs in the stomach followed by the small bowel, manifesting as gastrointestinal bleeding or simple mechanical obstruction. An inflammatory fibroid polyp manifesting as an intussusceptions in the colon is very very unusual. In this case report, we present an unusual case of colocolic intussusception due to an inflammatory fibroid polyp as the lead point.

CASE REPORT: A 45 years old patient presented with lower abdominal pain and diarrhoea with mucoid discharge for a period of 2 months. Clinical and perabdominal examination revealed no abnormality except for moderate degree of pallor. USG of abdomen and pelvis showed colocolic intussusception. CT scan of the abdomen and pelvis showed the bowel within bowel configuration of the ascending colon suggestive of colocolic intussusception. Barium enema showed obstructive pathology with defect in the ascending colon. Colonoscopy revealed a mass lesion in the ascending colon, occluding the lumen and hence the scope could not be negotiated beyond the mass lesion. The patient underwent a diagnostic laparoscopy, the colocolic intussusception was identified. Laparoscopically, by a 4- port approach, right hemicolectomy was done. Ileo-transverse anastomosis was done by bringing the bowel loops out by a small incision. The anastomosis was carried out by a linear cutter and stapler. The cut open specimen showed a pedunculated polypoidal lesion at the leading edge of the intussusception. Histopathology showed a polypoidal lesion suggestive of an inflammatory fibroid polyp. There was no evidence of malignancy. The postoperative period was uneventful. The patient is doing well after a period of one year.

Session: Poster Presentation

Program Number: P026

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