Case presentation:
A 49-year-old male with no past medical history, never operated on the
abdomen, presented to the Emergency Department with 3-day history of the
obstructive syndrome. Physical exam showed a distended, tympanic
abdomen. Digital rectal examination did not find palpable mass. A CT
scan showed a left colo-colic intussusception with a dilated proximal
colon (Fig 1.a) . Axial abdominal CT scan view showed a typical
target sign of intussuscepted bowel (Fig 1.b) . The patient was
admitted and underwent emergency laparotomy after a short time of
resuscitation. Intraoperatively finding confirmed imagery data. There
was an obstruction with distension of the small bowel, caecum,
transverse colon ahead of colo-colic intussusception. A hard mass was
palped within the intussuscepted bowel. There were neither hepatic
metastases nor peritoneal nodes. The manual reduction was not attempted,
and we performed a left oncological colectomy (Fig 2) with a
double-barrel colostomy. The postoperative course was uneventful, and
the patient was discharged after six days. Histopathological examination
revealed a well-differentiated adenocarcinoma with mucinous component
20%; there were free surgical margins. Fifteen lymph nodes were found.
The final pathology staging was T3N0M0. Immunohistochemically staining
showed a stable microsatellite profile. Then the patient was referred to
the oncology department for six cycles of FOLFOX spread over six months.
Ten months after surgery, he had a negative colonoscopy and repeated
abdominal CT scan without local recurrence of metastases. So Restoration
of Bowel Continuity was performed.