Colonic intussusception due to filiform polyposis of ulcerative colitis treated by endoscopic reduction

A 20-year-old man with ulcerative colitis presented with epigastric pain and hematochezia. Vital signs were stable and no peritoneal irritation signs were observed. Contrast-enhanced abdominal computed tomography showed a target sign in the descending colon, and he was diagnosed with intussusception ([Fig. 1]). After consulting surgeons, we first attempted to perform colonoscopy for diagnosis and reduction. A colonoscope (CF-Q260DI; Olympus, Tokyo, Japan) was inserted under fluoroscopy ([Fig. 2]). No obvious necrotic findings were observed in the mucosa. A huge granule-aggregating mass was found in the descending colon, and intussusception due to this mass was easily reduced by endoscopic CO₂ insufflation. After endoscopic reduction, we advanced the endoscope and confirmed that the mass was originally located near the hepatic flexure of the transverse colon ([Fig. 3]), and the intussusception had been completely reduced ([Video 1]). The biopsy specimen taken from the mass was revealed to be an inflammatory polyposis (filiform polyposis) [1]. On the second day, as the abdominal pain was reduced and normal bowel movement was established, the patient started taking his meals and was discharged the following day.

Fig. 1 Contrast-enhanced abdominal computed tomography showed a target sign in the descending colon, and the patient was diagnosed with intussusception.

Fig. 2 No obvious necrotic findings were observed in the mucosa. A huge granule-aggregating mass was found.

Fig. 3 After endoscopic reduction, we advanced the endoscope and confirmed that the mass was originally located near the hepatic flexure of the transverse colon.

Video 1 Colonic intussusception due to filiform polyposis of ulcerative colitis treated by endoscopic reduction

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Because intussusception in adults is rare, optimal treatment remains controversial [2]. A colonoscopy is a useful tool not only for endoscopic reduction but also for pathological diagnosis of the lead point of intussusception [3]. Filiform polyposis is a rare entity that is associated with inflammatory bowel disease [4]. It is a rare cause of the lead point of intussusception.

We successfully performed endoscopic reduction in a patient who had intussusception with ulcerative colitis and filiform polyposis and thus avoided emergency surgery. This method might be helpful for patients with intussusception.

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• References

• 1 Heng JS, Baird A, Novelli MR. et al. Filiform polyposis secondary to colonic tuberculosis presenting as acute colo-colonic intussusception. Case Rep Surg 2015; 2015: 578263
• 2 Hong KD, Kim J, Ji W. et al. Adult intussusception: a systematic review and meta-analysis. Tech Coloproctol 2019; 23: 315-324
• 3 Imasato M, Kim HM, Higashi S. et al. Laparoscopic surgery for idiopathic adult intussusception successfully reduced by colonoscopy. J Anus Rectum Colon 2019; 29: 49-52
• 4 Ruiz de la Hermosa A, Burdaspal-Moratilla A, Paseiro-Crespo G. et al. Filiform polyposis. A rare complication in a patient with inflammatory bowel disease. Rev Gastroenterol Mex (Engl Ed) 2022; 87: 103-105