Whereas most cases of intussusception are managed nonoperatively in children, surgical management is the treatment of choice for adults. The involved bowel is resected when either diagnosed preoperatively or discovered at the time of an emergency laparotomy. Minimally invasive bowel resection and anastomosis can be safely performed. Laparoscopy also offers an accessible and useful tool for differential diagnosis. Depending on the surgeon's experience and preference, an open procedure is an acceptable alternative.
Because many adults with intussusception have lead points, reduction before resection is controversial. Bowel resection without prior reduction is the clear management choice for colocolic intussusception, which has a high risk for malignancy. Avoidance of reduction in these cases may reduce the possibility for the spread of malignant cells. Reduction should also be avoided in patients with an ischemic or inflamed bowel. The risk that mucosal necrosis may extend beyond the resection margins is increased after reduction.[7,8]
In this case, after review of the CT images of the abdomen, the physician in the ED consulted a general surgeon, to whose care the patient was admitted. After admission, the patient was brought to the operating room, where the surgical team elected to perform a colonoscopy as the initial procedure. This revealed a large mass completely obstructing the lumen of the transverse colon. Exploratory laparotomy was planned after the endoscopic examination, at which time the diagnosis of colocolic intussusception was confirmed. The involved bowel was resected, and elective cholecystectomy was performed. Pathologic examination for the colonic mass was positive for moderately differentiated adenocarcinoma, which was discovered to arise from a large tubular adenoma in the transverse colon.
Postoperatively, the patient fared well, and she was discharged to home on hospital day 6. She was to receive outpatient follow-up care with general surgery and oncology.
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