EP-555 The telescoping sigmoid – a rare presentation of acute large bowel obstruction

Background

Adult bowel intussusception is a rare cause of bowel obstruction (1–5%) and requires urgent treatment, usually emergency surgery.

Aim

We wish to highlight the diagnosis and management of the rare entity of acute bowel obstruction secondary to intussusception with our adult patient with sigmoid colon intussusception.

Case presentation

We present a 65 years old male who attended with constipation, abdominal discomfort and per-rectal bleeding. Clinical examination revealed multiple subcutaneous lipomas, mild LUQ tenderness and large ‘lump’ 10 cm from anal verge on rigid sigmoidoscopy. CT abdomen/pelvis showed intussusception of the sigmoid into the rectum with a large ‘polyp’ as the lead point. On- table Flexible sigmoidoscopy was unsuccessful in reducing the intussusception. We proceeded to laparotomy with reduction of intussusception, high anterior resection with end- to- end stapled anastomosis. He made an excellent recovery. Post-operative histology which was reviewed in detail in MDT did not reveal any neoplastic/lipomatous lesion to account for the intussusception. The patient was very well on outpatient review.

Conclusion

Adult bowel intussusception is rare (5% of all intussusceptions), especially in the left colon. When it does occur, it is usually secondary to lipoma, neoplasm, or nodal mass acting as a lead point. These patients can be diagnostically challenging due to lack of clear obstructive symptoms on presentation. Early diagnosis (via a CT scan) and treatment of adult colonic intussusception (usually via surgery) is necessary to avoid serious complications such as bowel perforation/peritonitis. Postoperative histology review is also imperative to plan any appropriate further management.