Date Published: July 10, 2020
Publisher: Wolters Kluwer
Author(s): Abdelwahab Ahmed, Jinyu Zhang, Kutait Anas.
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.
An intussusception during or after colonoscopy is an extremely rare occurrence. Only 12 cases could be identified through a thorough PubMed search—2 of which are pediatric cases. Most cases involved a visit to the emergency department with peritoneal signs (i.e., diffuse abdominal pain, vomiting, or nausea), and all but 2 cases (including the present case) required surgical intervention. In every case, the diagnosis was confirmed with a computed tomography scan before an approach was chosen. Of the 2 cases not requiring surgical management, one required endoscopic intervention via colonoscopy, whereas the other had symptom resolution with conservative management only. To our knowledge, this is the only recorded case of colo-colonic intussusception after colonoscopy treated successfully with only pain management and observation. We suggest that conservative management be carefully considered in the setting of similar cases.
A 42-year-old woman with no surgical history and no significant medical history other than diarrhea for 2 months presented to our office with a 3-month history of abdominal pain and diarrhea. The pain was not associated with nausea, vomiting, dysphagia, or blood in the stool. Colonoscopy was performed electively to investigate the cause of her chronic diarrhea.
Intussusception is among the rarest causes of bowel obstruction in adults and is much more prevalent in childhood.1 In adults, approximately 70%–90% are associated with an identifiable lesion serving as a lead point.2 In most cases, this lesion is reflective of an underlying malignancy, which is managed by resection of the intussuscepted bowel. However, colonoscopy-induced intussusception may not need to be treated, similarly, because there is a possibility of spontaneous resolution with conservative management. Other causes of adult intussusception include benign tumors, celiac disease, inflammatory bowel disease, appendicitis, pancreatitis, and foreign bodies, although these account for a much smaller proportion of cases; these cases are managed by surgical resection of the intussuscepted bowel.3 Currently, there are a few hypotheses to explain the etiology of colonoscopy-induced intussusception.
Author contributions: A. Ahmed wrote the manuscript. J. Zhang and K. Anas edited the manuscript. K. Anas is the article guarantor.