Discussion:
Intussusception is defined as the
telescoping of the proximal loop of the intestine into the distal loop
resulting in obliteration of the lumen. Intussusception in the small
bowel seems to be most common than intussusception in the large bowel.
Whereas intussusception is relatively common in children, it is
clinically rare in adults [2]. Approximately 50% of the colonic
intussusception in adults are due to malignant tumours [3,4,5].
Apart from malignant etiologies, there are other causes of colonic
intussusception, such as submucosal lipomas, adenomatous polyps and
leiomyomas. The clinical signs are polymorphic and often misleading,
such as an acute intestinal obstruction, a sub-occlusive syndrome or
sometimes a nonspecific abdominal syndrome [6]. Because of these
nonspecific symptoms, intussusception can be misdiagnosed. Increased
computed tomography scan to evaluate patients with abdominal pain can
contribute to a reliable preoperative diagnosis. The abdominal
ultrasound associated with colour Doppler is a rapid examination that
can reveal the invagination coil [1], but it is not useful in
diagnosing adult intussusceptions. The CT scanner has proved to be more
accurate, with an accuracy of almost 100%, by showing two typical
images: a ”sandwich” image in longitudinal section showing the head of
the acute intestinal invagination and a ”cockade” image in cross-section
showing the coil of the acute intestinal invagination [7]. The
surgical approach is influenced by the prevalence of associated
malignancy, the anatomic site, and various local factors such as the
degree of associated ischemia of the involved bowel [2]. Primary
surgical resection without prior reduction is the treatment of choice in
colocolic adult intussusception [8,9,10].