A Case Report: Case of Megacolon due to Bowel Intussusception in an Elderly Patient

Abstract

Introduction: Intussusception is the telescoping of a proximal segment of the gastrointestinal tract into the lumen of the more distal segment. A rare but still encountered entity, bowel intussusception, is a surgical emergency that should not be taken lightly. Although it is common in those under two years of age, it is one of the less likely diagnoses in adult populations, with only 5% of all cases occurring in adults.

Case Presentation: We report the case of an 86-year-old gentleman who presented to the Emergency Department (ED) complaining of abdominal distension. An abdominopelvic CT scan with IV contrast showed evidence a transition point at the level of the sigmoid, with a small bowel of normal caliber and a homogenously dilated colon reaching 16 cm in its largest diameter. An exploratory laparotomy was opted for during which a colectomy was performed. Pathology results revealed chronic sigmoidal diverticulitis causing severe luminal narrowing with moderate chronic nonspecific inflammatory changes and acting as a lead point for intussusception, thus leading to obstruction, and megacolon.

Conclusion: Intussusception is a challenging entity in terms of diagnosis and treatment when it occurs in adults. Clinical symptoms are usually nonspecific and imaging features are variable, making the preoperative diagnosis often missed or delayed. Up to 20% of cases are idiopathic, with the rest being secondary to an organic cause that must be determined for proper management. Laparotomy remains the best way to diagnose adult intussusception and to determine any underlying pathology for adequate treatment.