EP-555 The telescoping sigmoid – a rare presentation of acute large bowel obstruction. (9th August 2022)

• Record Type: Journal Article
• Authors: Al-Sabbagh, Ali; Alseifi, Shaker; Kaur, G
• Is Part Of: British journal of surgery. Volume 109(2022)Supplement 5
• Publication Date: 2022-08-09
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1093/bjs/znac245.130
• Languages: English
• ISSNs: 0007-1323

Abstract

Abstract: Background: Adult bowel intussusception is a rare cause of bowel obstruction (1–5%) and requires urgent treatment, usually emergency surgery. Aim: We wish to highlight the diagnosis and management of the rare entity of acute bowel obstruction secondary to intussusception with our adult patient with sigmoid colon intussusception. Case presentation: We present a 65 years old male who attended with constipation, abdominal discomfort and per-rectal bleeding. Clinical examination revealed multiple subcutaneous lipomas, mild LUQ tenderness and large 'lump' 10 cm from anal verge on rigid sigmoidoscopy. CT abdomen/pelvis showed intussusception of the sigmoid into the rectum with a large 'polyp' as the lead point. On- table Flexible sigmoidoscopy was unsuccessful in reducing the intussusception. We proceeded to laparotomy with reduction of intussusception, high anterior resection with end- to- end stapled anastomosis. He made an excellent recovery. Post-operative histology which was reviewed in detail in MDT did not reveal any neoplastic/lipomatous lesion to account for the intussusception. The patient was very well on outpatient review. Conclusion: Adult bowel intussusception is rare (5% of all intussusceptions), especially in the left colon. When it does occur, it is usually secondary to lipoma, neoplasm, or nodal mass acting as a lead point. These patients can be diagnostically challenging due to lack of clear obstructive symptoms on presentation. Early diagnosis (via a CT scan) and treatment of adult colonic intussusception (usually via surgery) is necessary to avoid serious complications such as bowel perforation/peritonitis. Postoperative histology review is also imperative to plan any appropriate further management.