Post Colonoscopy Colonic Intussusception Reduced via a Laparoscopic Approach

Colo-colonic intussusception as a rare complication of colonoscopy with polypectomy: Two case reports

BACKGROUND

Colonoscopy is the most frequently used diagnostic and therapeutic tool for the treatment of colorectal diseases. Although the complication rate is low, it can be potentially serious. Intussusception is a rare and severe complication often associated with polypectomy. Only a handful of post-colonoscopy intussusception cases have been reported, making this study a valuable addition to the medical literature.

CASE SUMMARY

Case 1: A 61-year-old man underwent colonoscopy with polypectomy for chronic abdominal pain. The patient experienced abdominal pain 11 hours later but was still discharged after pain management. He was readmitted due to recurring pain. Computed tomography (CT) showed colo-colonic intussusception. Initial conservative management and attempts at endoscopic reduction failed; therefore, laparoscopic right hemicolectomy was performed. Histopathological examination revealed tubular adenomas in the polyps and inflammation in the resected specimens. Case 2: A 59-year-old woman underwent colonoscopy with polypectomy for a polyp in the transverse colon. She experienced upper abdominal pain, fever, nausea, and vomiting 9 hours after the procedure. Emergency CT and blood tests revealed a colo-colonic intussusception near the hepatic flexure and an elevated white blood cell count. Initial attempts at endoscopic reduction failed and conservative treatment showed no improvement. She underwent successful laparoscopic reduction and recovered uneventfully. Histopathological examination of the resected polyp revealed hyperplasia.

CONCLUSION

Post-colonoscopy intussusception in adults is rare, and polypectomy may contribute to its occurrence. Early diagnosis is crucial, with prompt CT examination serving as key. After excluding malignancies, conservative management and reduction of intussusception should be considered before surgical bowel resection.

Colonic intussusception after endoscopic mucosal resection successfully managed by endoscopic procedure

Adult-onset intussusception, particularly associated with colonoscopy, is extremely rare. A 78-year-old man, referred to our hospital for colonic endoscopic mucosal resection (EMR), experienced subsequent dull abdominal pain, as well as elevated peripheral blood leukocytosis and C-reactive protein levels. Abdominal computed tomography (CT) revealed a colocolonic intussusception at the hepatic flexure. Emergency colonoscopy revealed ball-like swollen mucosa distal to the EMR site of the ascending colon. The mucosa was intact without necrosis. The endoscopic approach was able to temporarily release the intussusception. A transanal drainage tube was inserted through the endoscope to prevent relapse. Both CT and colonoscopy showed release of the intussusception. Our case underscores the importance of considering colocolonic intussusception in post-colonoscopy abdominal pain, advocating for endoscopic management after excluding mucosal necrosis.

Intussusception after colonoscopic polypectomy: a rare complication

We present a patient who developed an ileocolic intussusception within a few hours of undergoing an endoscopic polypectomy found on screening colonoscopy. She underwent a laparoscopic right hemicolectomy with intracorporeal anastomosis. Final histopathological examination showed no evidence of malignancy. Intussusception after colonoscopy is a rare complication, and only 11 cases have been reported prior to this case. Laparoscopic resection with intracorporeal anastomosis is a safe and feasible option in patients who are not candidates or failed conservative management.

Intussusception in a Routine Colonoscopy

We present a 42-year-old woman who developed colo-colonic intussusception of the transverse colon near the hepatic flexure within a few hours after a routine colonoscopy. After conservative management with pain medication and hydration, her symptoms completely resolved within 24 hours. Colonic intussusception after a colonoscopy is rare, and the present case describes the most conservative approach leading to a complete resolution of symptoms.

Early Postendoscopic Transverse Colo-Colonic Intussusception

Intussusception is defined as telescoping of the proximal bowel (intussusceptum) into the lumen of the distal bowel, otherwise called the intussuscipiens. While it is one of the most common causes of intestinal obstruction in children between the ages of 3 months and 6 years, intussusception accounts for about 1% of such cases in adults. Intussusception is idiopathic in 8–20% of patients and most commonly occurs in the small intestines in adults. We describe the unique case of a colo-colonic intussusception in a 54-year-old female patient 1 week after a colonoscopy for suspected inflammatory bowel disease. The discussion focuses on the presentation and management options of intussusception.

Laparoscopic surgery for idiopathic adult intussusception successfully reduced by colonoscopy

Most cases of adult intussusception are caused by neoplastic lesions, and idiopathic adult intussusception is very rare. We present a case in which laparoscopic surgery was performed for idiopathic adult intussusception initially reduced by colonoscopy. A 53-year-old woman presented to the emergency department of our hospital with intermittent lower abdominal pain. Contrast-enhanced computed tomography and ultrasonography of the abdomen showed a concentric structure in the ascending colon. We diagnosed intussusception. Colonoscopy achieved successful reduction before surgery. Twelve days after this reduction, laparoscopic surgery was performed. Histopathological examination did not reveal any causative pathology; therefore, idiopathic adult intussusception was diagnosed. The postoperative course was uneventful, and the patient was discharged on postoperative day 14. Preoperative colonoscopy should be utilized to diagnose the main lesion and may be useful for reducing adult intussusception. Laparoscopic surgery is both minimally invasive and safe and can be performed following endoscopic reduction.

Intussusception after Colonoscopy: A Case Report and Review of Literature

Intussusception after colonoscopy is an unusual complication. A MEDLINE search revealed only 7 reported cases. We present a report of a 28-year-old man who developed abdominal pain several hours after routine colonoscopy and in whom computed tomography (CT) revealed colocolic intussusception. We postulate that this condition is iatrogenic and induced by suctioning of gas on withdrawal of the colonoscope. A common observation among the reported cases was abdominal pain several hours after colonoscopy and right-sided intussusception. All cases had colonoscopy reaching the right side of the colon. Treatment for adult intussusception remains controversial with regard to reduction versus resection, especially given the high association with a pathological cause and malignancy. Among the 8 reported cases, only the current case did not require surgery. A combination of benign colonoscopy, CT, and the clinical picture should provide sufficient information to initially choose a more conservative treatment approach.

Intussusception after Routine Colonoscopy: A Rare Complication

We present a 31-year-old woman who developed ascending colon intussusception several hours after a routine colonoscopy where random mucosal biopsies were obtained. She underwent an ileocolic resection, and pathology did not show an etiology for the intussusception. Colonic intussusception occuring without pathology and after minimal intervention is rare.

Adult colo-colonic intussusception caused by congenital bands: A case report and literature review

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Adult colo-colonic intussusception is predominantly associated with a pathologic lead point.

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First description of adult colo-colonic intussusception caused by congenital bands.

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Treatment typically involves en-bloc resection due to concern of malignancy.

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Laparoscopic techniques are safe, feasible, and may enhance recovery.

Introduction

Intussusception refers to the telescoping of a segment of bowel into the lumen of an adjacent segment. While pediatric intussusception is common and generally idiopathic, adult intussusception is exceedingly rare and is usually attributable to a pathologic lead point.

Presentation of case

37-year-old man who presented with abdominal pain, and was preoperatively diagnosed with a colo-colonic intussusception. Intraoperatively, the lead point was found to be congenital bands, and there was no evidence of underlying malignancy. He underwent a laparoscopic-assisted extended right hemicolectomy with side-to-side ileo-colic anastomosis.

Discussion

Colo-colonic intussusception is a rare cause of intestinal obstruction in adults. Patients generally present with subacute abdominal pain and obstructive symptoms, rendering the clinical diagnosis challenging. Computed tomography has been shown to be the most accurate diagnostic imaging modality. Due to the high incidence of underlying malignancy in adult colo-colonic intussusception, en-bloc resection of the involved bowel segment remains the standard of care.

Conclusion

Congenital bands can serve as a lead point in colo-colonic intussusception, particularly in younger adults. Prompt surgical intervention remains paramount to limit morbidity.

Adult colonic intussusception: Surgery still the best option

Intussusception is the telescoping of proximal bowel wall into the lumen of a distal segment. Whilst it is common in children, intussusception in adults is rare, and predominantly occurs secondary to an underlying malignant neoplasm. Abdominal and pelvic computed tomography (CT) is preferred for detection of lead points and lesion localisation. We present the case of a 79-year-old female with a four-day history of colicky abdominal pain followed by obstipation and distension. CT demonstrated a rounded heterogeneous density protruding into the upper rectal lumen, and also left-sided colonic obstruction. Emergency laparotomy revealed a mid-sigmoid colonic mass intussuscepting into the rectum. Histopathology confirmed a T3N1 moderately differentiated colonic adenocarcinoma. Given the high likelihood of underlying malignancy, surgical reduction of the intussusceptum may be complicated by perforation and tumour spillage. En bloc resection using oncologic surgical principles remains the first line treatment.

Colonoscopy Leads to A Diagnosis of A Jejunal Gastrointestinal Stromal Tumour (GIST)

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors in the gastrointestinal (GI) tract, but are the least common of small intestinal malignant neoplasms. While GI bleeding is the most common clinical presentation of GISTs, intussusception and obstruction are uncommon, as GISTs rarely grow into the lumen. We describe an unusual case of a 50-year-old male who presented with intermittent obscure, overt GI bleeding requiring multiple hospital admissions and blood transfusions. His work-up included abdominal CT imaging, small bowel follow-through, gastroscopies, push enteroscopy, colonoscopies, and anterograde and retrograde double-balloon enteroscopies. Complicating his presentation were colonic angiodysplasias and the development of recurrent venous thromboembolism requiring anticoagulation. Within an hour after an apparently uncomplicated colonoscopy, he developed an acute abdomen secondary to a jejunal intussusception, which led to a laparoscopic small bowel resection and the diagnosis of a jejunal GIST. Given his GIST had no high-risk features, ongoing surveillance with abdominal CT imaging was arranged. This case illustrates the complex presentation and diagnostic difficulty of a jejunal GIST causing obscure, overt GI bleeding and this is the first reported case of a jejunal intussusception following colonoscopy. Due to its submucosal location, multiple endoscopic approaches had failed to diagnose the GIST prior to surgery.