Adult intussusception secondary to an appendiceal tumour in a patient with ulcerative colitis: a case report

Appendiceal Mucinous Neoplasms and Inflammatory Bowel Disease: Systematic Review of the Literature

There is no clear evidence on the prevalence and clinical presentation of appendiceal mucinous neoplasm (AMN) among patients with inflammatory bowel disease (IBD), so a systematic review was performed to investigate the diagnosis, management and treatment of AMN in these patients. PubMed, Medline, Scopus and the Cochrane Library were searched for articles published up to September 2023. Twenty-three studies reporting data about 34 AMN patients were included. UC patients had a median age of 52 years and a median length of disease of 10 years; CD patients had a median age of 40.5 years and a median length of disease of 5 years. A pre-operative diagnosis was achieved in 44% of patients. Most patients were symptomatic (82.6%) and showed moderate-severe disease activity (61%). Surgical procedures were performed: laparoscopic appendectomy, ileocecal resection, right hemicolectomy and colectomy/proctocolectomy. Of the patients, 73.5% were diagnosed with low-grade mucinous neoplasm (LAMN) and nine with adenocarcinoma. Synchronous colorectal dysplasia/carcinoma was present in 23.5% of patients. IBD patients with long-standing disease should be routinely screened, not only for colorectal cancer but also for AMN, during gastro-enterologic follow-up. Laparoscopic appendectomy of unruptured LAMN as well as right hemicolectomy of non-metastatic adenocarcinoma are safe procedures in IBD patients.

Mucinous appendix intussusception: Case report

INTRODUCTION AND IMPORTANCE

Intussusception is an intestinal invagination of one bowel segment into another. It occurs mostly in children, but it can show in adults due to different etiologies. Appendiceal neoplasms are rare and can mimic an acute onset of appendicitis. Appendiceal mucinous neoplasm is one of the subtypes of appendiceal malignancies found in less than 1 % of appendectomies samples.

CASE PRESENTATION

We present the case of a 32-year-old woman with abdominal pain in the right upper quadrant, whose computed tomography revealed an ileocolic intussusception and a low-density tubular image in the distal loop. She underwent diagnostic laparoscopy and laparoscopic right colectomy. Biopsy results confirmed a LAMN with acute appendicitis and intussusception.

CLINICAL DISCUSSION

Appendiceal intussusception (AI) is associated with the alteration of peristalsis, in addition to multiple inflammatory conditions and diseases such as parasites, foreign bodies, Crohn's disease, and lymphoid hyperplasia. The pathophysiology of AI is not fully established, but the main appendicular alteration that has been associated with it is the presence of a tumor. AI lead points are typically pathological in 90 % of cases, 65 % of which are neoplastic in nature. Right hemicolectomy should be performed for tumors involving the periappendicular area or in those larger than 2 cm in size. Follow-up and surveillance colonoscopy is suggested.

CONCLUSION

Intussusception is a rare diagnosis in adults. However, malignancy should be suspected if identified.

Intussusception in the Setting of an Ulcerative Colitis Flare

Intussusception is an extraordinary cause of acute abdomen in adults and has been defined as the telescoping of a bowel segment into the lumen of an adjacent segment. A 43-year-old female presented to our hospital's emergency department (ED) with 10+ episodes of bloody diarrhea per day, left-sided abdominal pain, and the inability to tolerate oral intake for one month. She was initially diagnosed with ulcerative colitis (UC) ten years ago and is currently on mesalamine oral and enema therapy. She presented to our gastroenterology clinic two weeks after the beginning of her flare and was started on prednisone 40 mg daily. This did not improve her symptoms, and she presented to the ED two weeks later. She underwent a computed tomography (CT) abdomen/pelvis which revealed intussusception in the left hemiabdomen with no definite lead point measuring 5.6 cm in the craniocaudal dimension with pneumatosis and no evidence of bowel obstruction. There were no other significant laboratory abnormalities. Acute care surgery was consulted and suggested obtaining a CT enterography for further evaluation which showed spontaneous resolution of intussusception with no evidence of pneumatosis, portal venous gas, or intraperitoneal free air. She reports that following oral contrast intake, she "felt movement and relaxation" in her abdomen with substantial pain relief. Infectious workup was negative, and therapy was initiated with intravenous steroids. In conclusion, intussusception has been very rarely reported in patients with UC with the most common treatment being surgical resection. However, conservative management in the absence of bowel obstruction can be attempted.

Multiple intestinal hemangioma concurrent with low-grade appendiceal mucinous neoplasm presenting as intussusception-a case report and literature review

BACKGROUND

Cases with intussusception caused by either intestinal hemangiomas or appendiceal mucinous neoplasms are extremely rare.

CASE PRESENTATION

In this study, we reported a 47-year-old male presented with paroxysmal abdominal pain and postprandial bloating for 3 days. CT results indicated a high possibility of secondary intussusception in ascending colon. Histopathology indicated a mixed type of cavernous and capillary hemangioma, combined with low-grade appendiceal mucinous neoplasms (LAMNs) and intestinal obstruction. The patient underwent laparotomy and right hemicolectomy. Finally, the patient was followed up for 4 months with no disease progression.

CONCLUSIONS

Rare studies reported the intestine hemangiomas coincided with appendix low-grade mucinous tumor. Its manifestations are not specific, which is a challenge in the preoperative diagnosis. For cases with intussusception that was not observed in time, it may lead to intestinal necrosis and diffuse peritonitis. Additionally, the ruptured mucinous tumor in the appendix may lead to pathogenesis of pseudomyxoma peritonei. Therefore, accurate diagnosis and appropriate surgery-based treatment contribute to the improvement of prognosis and severe outcomes among these patients.

Adult Left Colocolic Intussusception Successfully Managed by Left Hemicolectomy and Primary Anastomosis

Intussusception, although quite common in children with the classic triad of cramping abdominal pain, bloody diarrhea, and palpable masses, is a rare cause of acute abdomen with myriad presentations in adults. It is defined as the telescoping of a proximal segment of the gastrointestinal (GI) tract, called the intussusceptum, into the lumen of the adjacent distal segment of the GI tract, called intussuscipiens. Due to its different manifestations and time course, adult colonic intussusception often poses a diagnostic challenge for emergency doctors. The treatment of colonic intussusception in adults typically involves surgery, often with bowel resection and anastomosis followed by a defunctioning loop ileostomy. We report a case of left-sided colocolic intussusception secondary to a tubular adenoma as the lead point, which was successfully treated by resection and primary anastomosis. The pathological diagnosis of the lesion was reported as adenocarcinoma and resected bowel margins were found free of the tumor.