Case report: Rare benign colorectal intussusception due to rectal polyp treated non operatively (2024)

Abstract

Keywords: Colorectal intussusception, Laparotomy, Conservative management, Spontaneous resolution, Management

Highlights

1. Introduction

Intestinal intussusception is a rare condition in adults. It occurs when one segment of the intestine telescopes into an adjacent segment, typically proximal to the distal portion [¹].

This condition is often associated with colonic lesions such as adenocarcinoma, lipoma, or polyps. Clinically, it presents as an acute obstructive syndrome. Diagnosis is typically made through CT tomography. Here, we report a rare case of colorectal intussusception secondary to a polyp at the rectosigmoid junction treated by endoscopic polypectomy.

This work has been reported in line with the SCARE 2023 criteria [²].

2. Case presentation

We present a case involving a 74-year-old man with a history of chronic constipation, managed with hygienic-dietary measures and laxatives without prior endoscopic evaluations. He sought emergency care due to acute abdominal pain, vomiting, and cessation of bowel movements and gas passage. Hemodynamically, he remained stable with a heart rate of 109 beats per minute and a blood pressure of 120/80mmHg. Physical examination revealed a distended and tympanic abdomen with diffuse tenderness. Hernial orifices were free, and rectal examination was unremarkable. Laboratory analysis showed a white blood cell count of 11.1×10^9/L, with other parameters within normal ranges.

To elucidate the obstructive syndrome's mechanism, site, etiology, and severity, we conducted a computed tomography scan. This revealed a telescoping with intussusception of the sigmoid colon into the rectum, leading to colorectal invagin*tion and colonic occlusive syndrome, without radiological signs of severe complications (Figs. 1; ​;2).2). Consequently, acute bowel obstruction secondary to colorectal intussusception was diagnosed, prompting a decision for surgical intervention following resuscitation and saline infusion.

During general anesthesia induction, a notable diarrheal episode ensued, coinciding with the complete resolution of abdominal distension. Subsequently, we opted to postpone surgical intervention for a more thorough patient evaluation. A subsequent colonoscopy identified a 10mm polyp at the rectosigmoid junction, which was promptly excised. Histopathological analysis of the polyp classified it as a villous adenoma with low-grade dysplasia and clear resection margins.

The patient's postoperative recovery was uneventful, and he was discharged three days post-polypectomy. Subsequent clinical and endoscopic follow-ups showed no abnormalities or recurrence of obstructive symptoms. A one-year follow-up colonoscopy yielded normal findings.

3. Discussion

Intussusception, a rare condition in adults, primarily affects the pediatric population but emerges in adulthood in only about 5% of cases. In adults, it contributes to between 1% and 5% of intestinal obstructions, with its main site being the small intestine in 90% of cases, though it can involve portions of the colon, particularly in ileocolic forms [³].

The etiology of adult intussusception differs from that in children, often stemming from organic lesions such as chronic inflammatory bowel disease, benign or malignant intraluminal lesions, metastases, foreign bodies, or postoperative adhesions. Idiopathic cases comprise about 8% to 20% of adult presentations [^{[3], [4], [5]}].

Colocolonic intussusceptions, although rarer, typically exhibit a malignant origin, except in cases where the causal lesion is benign, commonly a lipoma. While other lesions such as stromal tumors or adenomatous colonic polyps have been reported, they remain infrequent [^4,6,7].

The symptoms observed in adult patients with intussusceptions are typically nonspecific and may persist over a prolonged period. Pain stands out as the most prevalent symptom, reported in 71% to 90% of cases across various studies, followed by vomiting and rectal bleeding as the subsequent most common manifestations [⁷].

Prompt diagnosis is crucial, often facilitated by CT scans, especially in cases with few or nonspecific symptoms [⁸]. Other imaging modalities like plain radiographs, opaque enemas, or magnetic resonance imaging may also aid diagnosis, with some cases only confirmed during surgery [^7,9,10].

Treatment typically involves surgery, given the high incidence of malignant lesions in the colon or when the intussusception occurs in the small intestine [^6,7,9,10]. However, in selected cases where colonic intussusception results from a polypoid lesion, endoscopic resection may be appropriate.

4. Conclusion

Colorectal intussusception, although rare in adults, often requires laparotomy for treatment. However, it is crucial to recognize that in some cases, spontaneous resolution of symptoms allows for conservative management. Given its rarity and the potential for favorable outcomes without surgical intervention, clinicians must be familiar with this condition to avoid unnecessary and potentially risky laparotomies.

Declaration of generative AI in scientific writing

AI tools were not used for the elaboration of the manuscript.

Patient consent

Written informed consent was obtained from the patient for the publication of this case report and its accompanying images. A copy of the written consent is available for the Editor-in-Chief of this journal to review upon request.

Ethical approval

Ethical approval is not applicable/waived at our institution.

Funding

This research did not receive funding from any specific grant provided by public, commercial, or not-for-profit organizations.

Author contribution

Med Dheker Touati and Anis Belhadj contributed to manuscript writing andediting, and data collection; Mohamed Ridha Zayati and Fahd Khefacha contributed to data analysis; Ahmed Saidani and Faouzi Chebbi contributed to conceptualization and supervision; All authors have read and approved the final manuscript.

Research registration number

N/A.

Conflict of interest statement

No conflicts of interest.

References