P0278 - The Scope of Telescoping, Seen on Endoscope

Tevan Y.. Luong, BS¹, C Gregory Albers, MD, FACG², Natalie Hall, MD³, Valery Vilchez, MD⁴, Steve Huy D. Phan, BS, BA⁴, Whitney Li, BA⁵, Rishi Vermani, BS^6
1UC Irvine School of Medicine, Tustin, CA; ²UC Irvine Digestive Health Institute, Newport Coast, CA; ³UC Irvine Digestive Health Institute, Orange, CA; ⁴UC Irvine Digestive Health Institute, Irvine, CA; ⁵UC Irvine School of Medicine, San Jose, CA; ⁶UC Irvine School of Medicine, Irvine, CA

Introduction: Gastrointestinal intussusception (GII) is a condition characterized by the telescoping of bowel tissue, 90% of which in adults is caused by masses within the bowel. Intussusception is rare in adults, accounting for less than 5% of cases. GIIs primarily occur at the ileo-colic junction, but may rarely present exclusively in the colon in approximately 5-10% of cases. In this case, we present a unique instance of rectosigmoid intussusception (RSI) secondary to colorectal cancer in an adult male. Understanding the characteristics of intussusception, particularly in the rectosigmoid junction, may contribute to the development of specific diagnostic, management, and treatment strategies, potentially leading to improved patient outcomes.

Case Description/Methods: A 51-year-old man with a history of abdominal surgery was admitted to the hospital due to abdominal pain, hematochezia, anemia, and a 50-pound weight loss over the past 6 months. Abdominal exam at presentation and throughout hospital stay was benign. An abdominal contrast-enhanced computed tomography (CT) scan revealed evidence of a mass within the sigmoid colon. Due to improved symptoms and history of negative colonoscopy, a flexible sigmoidoscopy (FS) confirmed the presence of a RSI with a lead point due to a friable 10cm mass, confirmed on pathology to be a mucinous adenocarcinoma. Laparoscopic resection of the mass was performed, and the patient was discharged two days later without further complications.

Discussion: RSI typically manifests with chronic abdominal pain, hematochezia, diarrhea, nausea, and vomiting. Historically, laparoscopy diagnoses the cause of GII. However, choice of surgical management of GII depends on the location and size of the lesion. Early detection of intussusception is vital, given the risk of developing bowel ischemia, necrosis, perforation, and sepsis. This case presented with a fascinating twist—a 10cm mass detected by FS, which paradoxically presented with resolution of abdominal pain and intermittent diarrheal symptoms following the patient’s hospital admission. The utilization of FS as a quick and minimally invasive diagnostic tool to verify RSIs and the underlying lesion equips physicians with vital information for treatment planning and accelerates patient recovery. Thus, this case serves as a compelling teaching point, emphasizing the potential benefits of integrating endoscopic procedures into the current standard of care for assessing and managing rare obstructive gastrointestinal disorders.



Disclosures:


Tevan Y.. Luong, BS¹, C Gregory Albers, MD, FACG², Natalie Hall, MD³, Valery Vilchez, MD⁴, Steve Huy D. Phan, BS, BA⁴, Whitney Li, BA⁵, Rishi Vermani, BS⁶. P0278 - The Scope of Telescoping, Seen on Endoscope, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.