Bridgeport Hospital/Yale New Haven Health Bridgeport, CT
Jamil O. Alexis, MD, Hardik Patel, MD, Andrew Bedford, MD Bridgeport Hospital/Yale New Haven Health, Bridgeport, CT
Introduction: Intussusception in adults is a rare diagnosis, often associated with gastrointestinal malignancies that serve as intestinal lead points, leading to abdominal pain and obstructive symptoms. We present a unique case of symptomatic long ileocolic intussusception from a benign etiology treated with surgical resection.
Case Description/Methods: A 77-year-old woman sought outpatient evaluation for post-prandial abdominal pain, bloating, and occasional constipation. Physical examination was normal. Laboratory results were unremarkable, with normal complete blood count and comprehensive metabolic panels; while TSH was slightly elevated at 4.3. Initial upper endoscopy showed mild chronic antral gastritis. Subsequent CT imaging of the abdomen and pelvis revealed a "bowel within bowel" appearance measuring 13 cm in length, within the cecum, with extension of mesenteric fat, suggesting small bowel to large bowel intussusception. A subsequent colonoscopy revealed an extensive portion of the distal ileum telescoped into the colon, obstructing visualization of the cecum. The intussusceptum appeared erythematous and congested, with a firm broad-based ulceration in the proximal small bowel. Pathological examination revealed only chronic inflammation and acute ileitis with ulceration and granulation tissue, with no dysplasia. The patient underwent right hemicolectomy. Gross pathology and histology identified a 3.4x2.3cm hyperplastic small bowel polyp. The patient's post-operative course was uneventful, with resolution of her presenting symptoms.
Discussion: We present a rare case of ileocolic intussusception caused by a large hyperplastic polyp. Typically, 66-75% of intussusception cases involve malignancies as lead points, resulting in intestinal telescoping and obstructive symptoms. Our case highlights how benign ileal polyps can also cause ileocolic intussusception.
Figure: CT Abdominal imaging revealing “bowl within bowel” appearance suggestive of intussusception in Image A. Endoscopic view of protruding ileum obscuring view of the cecum in Image B. Gross pathology showing resected bowel revealing large hyperplastic polyp protruding from ileum in Image C.
Jamil Alexis indicated no relevant financial relationships.
Hardik Patel indicated no relevant financial relationships.
Andrew Bedford indicated no relevant financial relationships.
Jamil O. Alexis, MD, Hardik Patel, MD, Andrew Bedford, MD. P2688 - Benign Masquerade: Ileocolic Intussusception Caused by a Large Hyperplastic Polyp, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.