Sigmoido-rectal intussusception

Incarcerated Prolapsed Sigmoid Intussusception Presenting as Rectal Prolapse Without a Lead Point

This case series presents two patients with symptoms consistent with acute rectal prolapse. The prolapses were subsequently found to be sigmoid intussusception that had prolapsed through the anus without rectal prolapse and without any intraluminal pathology or lead point. Both were recognised on examination and underwent colonic resection rather than proctectomy.

Adult sigmoidorectal intussusception as an unexpected cause of lower gastrointestinal bleeding

A 95-years-old woman presented with sudden-onset rectal bleeding. All other systems were reviewed and were negative. The patient had a past medical history of Alzheimer disease, congestive heart failure, arterial hypertension and diabetes mellitus type 2. Vital signs were normal. There were neither signs of peritoneal irritation nor intestinal obstruction. On digital rectal examination, a soft mass was palpated about 9 cm from the anal verge. Routine analytical tests were within normal limits. The abdominal CT showed a sigmoidorectal intussusception. It was performed a colonoscopy revealing a segment of sigmoid telescoping into the rectum about 15cm from the anal verge. On this invaginated segment, there was a large sessile polyp, which was biopsied. Rectal bleeding was self-limited without additional measures. The histological examination showed tubular adenoma with high-grade dysplasia. Intussusception in the adult is uncommon, representing less than 5% of all cases of intussusception. Most of the cases are due to malignant lesions, which are pulled forward during peristalsis, leading to invagination. The early diagnosis represents a diagnostic challenge due to the clinical features are nonspecific, including symptoms of intestinal obstruction and rectal bleeding.

Sigmoid carcinoma with sigmoid-rectal intussusception presenting as rectal prolapse and large bowel obstruction in the ED

Background

Intestinal obstruction is a surgical emergency with most cases being small bowel obstruction. Large bowel obstruction is comparatively uncommon and colonic malignancies are a usual cause. Such lesions cause intestinal obstruction by luminal narrowing or rarely serve as lead point of intussusception.

Case presentation

Herein, we describe an unusual case of sigmoid carcinoma causing sigmoid-rectal intussusception, rectal prolapse, and eventually large bowel obstruction.

Conclusion

Pre-operative CT should be done in all adult large bowel obstruction to look for possible site and cause of obstruction and to rule out malignancy as a cause of obstruction. Conversely, every case of rectal prolapse should be diligently evaluated to rule out intussusception, which if present in an adult indicates a high likelihood of underlying malignancy.