Hospital: Hospital Universitario de burgos.
Aut@r o Autores: I.M. Bayona García, G. Fernández Matía, A. Fernández Fernández, L. Castaño Martín, A. Salazar Salgado, X. Leunda Ayastuy.
38 year old male who goes to the emergency department for abdominal discomfort of 15 days of evolution associated with catarrhal disease in treatment. In the last days worsening of the pain and insomnia with decubitus intolerance due to epigastric pain, presents loss of appetite and 2-3 Kg of weight in the last 2 weeks. On examination it is noticed a soft and depressed abdomen with a discomfort to palpation in the epigastrium and no signs of peritoneal irritation. Normal blood presure, cardiac frequency, temperature and oxygen saturation. In analytical test mild leukocytosis with left deviation and elevation of C reactive protein. Abdominal ultrasound is performed, detecting in mesogastrium heterogeneous lesion "on target" with alternating hypo and hyperechoic layers. Study is completed with multidetector computed tomography confirming colo-colic invagination of about 19 cm in length, located in transverse colon with mesenteric drag and tumor of 5 cm in diameter hipodense with hiperdense septa, with attenuation values in fatty range, suggestive of lipoma. It is associated reticularity of transverse mesocolon fat and retrograde distension of caecum and ascending colon. The patient is surgically treated with regulated right-sided hemicolectomy with end-to-side ileocolic anastomosis. The piece is opened, showing as a cause of the invagination a polypoid lesion with a degenerated head. In the anatomopathological study a 7 x 5 cm polypoid lesion with an ulcerated surface and a large fixation pedicle 3 cm in diameter is identified, to the cut constituted by yellowish tissue of adipose appearance with diagnosis of great submucosal lipoma with large areas of superficial ulceration.
Intestinal intussusception is a rare entity in adults, constituting only 5% of cases of intussusception occurring the remaining 95%in pediatric age. 75-80% occur in the small intestine, the rest in the colon. In adults the mayority of cases present an underlaying organic lesion capable of altering the peristalsis causing an intestinal segment to telescope in another distal segment occurs intussusception. Abdominal ultrasound is a good initial diagnostic tool, allowing differential diagnosis with other entities that present abdominal pain, showing image "on target" characteristic, with a sensivity 100% and specificity 88%. Computed tomography allows assessment of etiology and contributes to staging in the case of malignant lesions.
Imaging test play a decisive role in the diagnosis of intussusception with elevated sensitivity and specificity, contributing to an adecuate therapeutic orientation. The most recommended surgical treatment is intestinal resection without prior reduction of intussusception.
- Kim YH, Blake MA, Harisinghan MK, Archer-Arroyo K, Hahn PF, Pitman MB et al. Adult intestinal intussusception CT appearances and identification of a causative lead point. Radiographics 2006, 26:733-744. - Sundaram B, Miller CN, Cohan RH, Schipper MJ,