Endoscopy 2022; 54(08): E464-E465
DOI: 10.1055/a-1625-5105
E-Videos

Endoscopic management of colocolic intussusception in an adult with colonic stent placement

Raosaheb Rathod
Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Mumbai, India
,
Sridhar Sundaram
Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Mumbai, India
,
Aadish Kumar Jain
Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Mumbai, India
,
Kiran Mane
Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Mumbai, India
,
Prachi Patil
Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Mumbai, India
,
Shaesta Mehta
Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Mumbai, India
› Author Affiliations
 

A 47-year-old man with a history of gastric cancer, initially treated by subtotal gastrectomy, with subsequent recurrence in the periampullary region and peritoneal metastases, presented with abdominal distension and obstipation for 3 days. He was started on intravenous hydration and kept nil per os. A computed tomography (CT) scan of the abdomen showed involution of the right-sided colon and neighboring peritoneal thickening, with a target sign, and dilated cecum and small-bowel loops, suggestive of right-sided colocolic intussusception ([Fig. 1]).

Zoom Image
Fig. 1 Computed tomography scan of the abdomen showing colocolic intussusception, with the target sign (arrow).

In view of his metastatic disease, the patient was referred for colonoscopy and decompression. Colonoscopy was done with a distal transparent attachment using a flushing pump. Edematous infiltrated mucosa, with involuted bowel and luminal narrowing was seen at the hepatic flexure. The colonoscope was negotiated beyond the narrowing with gentle manipulation ([Fig. 2]). A 25 × 90-mm WallStent colonic self-expanding metal stent (SEMS; Boston Scientific, Marlborough, Massachusetts, USA) was placed across the narrowing under fluoroscopic guidance ([Fig. 3]; [Video 1]). The distal end of the stent was fixed with clips. The patient improved with free passage of stools and flatus. Plain radiography of the abdomen on the evening of the procedure showed the expanded SEMS, with no evidence of dilated bowel ([Fig. 4]).

Zoom Image
Fig. 2 Endoscopic image of the infiltrated segment at the hepatic flexure of the colon, which was acting as the lead point for the intussusception.
Zoom Image
Fig. 3 Fluoroscopic image showing the colonic self-expanding metal stent deployed over the guidewire.

Video 1 Management of colocolic intussusception in an adult by placement of a colonic stent.


Quality:
Zoom Image
Fig. 4 Plain radiograph of the abdomen post-stent placement showing the expanded colonic stent and no evidence of bowel dilatation, with a biliary self-expanding metal stent also visible.

Intussusception is a rare cause of colonic obstruction, with the colon accounting for 5 % of all instances of intussusception [1]. In adults, about half of bowel intussusceptions result from malignancy, with surgical resection being required in 72 % of patients [2]. Endoscopic management of ileocecal intussusception with hyperinsufflation at the lead point has been described previously [3]. In adults, intussusception is managed mostly with surgery, unlike in children where it is managed conservatively [4], although recurrence of intussusception is known to occur in up to 20 % children after conservative management [5]. In this case, SEMS placement was planned to prevent recurrent episodes of intussusception as surgery was deferred owing to the metastatic disease. To the best of our knowledge, no previous reports of the endoscopic management of colocolic intussusception are available.

Endoscopy_UCTN_Code_TTT_1AQ_2AF

Endoscopy E-Videos
https://eref.thieme.de/e-videos

Endoscopy E-Videos is an open access online section, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high quality video and all contributions are freely accessible online. Processing charges apply (currently EUR 375), discounts and wavers acc. to HINARI are available.

This section has its own submission website at https://mc.manuscriptcentral.com/e-videos


#

Competing interests

The authors declare that they have no conflict of interest.

  • References

  • 1 Wilson A, Elias G, Dupiton R. Adult colocolic intussusception and literature review. Case Rep Gastroenterol 2013; 7: 381-387
  • 2 Barussaud M, Regenet N, Briennon X. et al. Clinical spectrum and surgical approach of adult intussusceptions: a multicentric study. Int J Colorectal Dis 2006; 21: 834-839
  • 3 Averbach M, de Rezende Zago R, Popoutchi P. et al. Adult ileocolic intussusception: endoscopic treatment. Gastrointest Endosc 2015; 81: 464-465
  • 4 Khan Z, Darr U, Renno A. et al. Transient descending colonic intussusception due to a large fecaloma in an adult. ACG Case Rep J 2017; 4: e94
  • 5 Hsu WL, Lee HC, Yeung CY. et al. Recurrent Intussusception: when should surgical intervention be performed?. Pediatr Neonatol 2012; 53: 300-303

Corresponding author

Raosaheb Rathod, MD, DM
Department of Digestive Diseases and Clinical Nutrition
Tata Memorial Hospital, Homi Bhabha National Institute
Dr. E Borges Road
Parel
Mumbai 400012
India   

Publication History

Article published online:
27 September 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

  • References

  • 1 Wilson A, Elias G, Dupiton R. Adult colocolic intussusception and literature review. Case Rep Gastroenterol 2013; 7: 381-387
  • 2 Barussaud M, Regenet N, Briennon X. et al. Clinical spectrum and surgical approach of adult intussusceptions: a multicentric study. Int J Colorectal Dis 2006; 21: 834-839
  • 3 Averbach M, de Rezende Zago R, Popoutchi P. et al. Adult ileocolic intussusception: endoscopic treatment. Gastrointest Endosc 2015; 81: 464-465
  • 4 Khan Z, Darr U, Renno A. et al. Transient descending colonic intussusception due to a large fecaloma in an adult. ACG Case Rep J 2017; 4: e94
  • 5 Hsu WL, Lee HC, Yeung CY. et al. Recurrent Intussusception: when should surgical intervention be performed?. Pediatr Neonatol 2012; 53: 300-303

Zoom Image
Fig. 1 Computed tomography scan of the abdomen showing colocolic intussusception, with the target sign (arrow).
Zoom Image
Fig. 2 Endoscopic image of the infiltrated segment at the hepatic flexure of the colon, which was acting as the lead point for the intussusception.
Zoom Image
Fig. 3 Fluoroscopic image showing the colonic self-expanding metal stent deployed over the guidewire.
Zoom Image
Fig. 4 Plain radiograph of the abdomen post-stent placement showing the expanded colonic stent and no evidence of bowel dilatation, with a biliary self-expanding metal stent also visible.