Mesa Natalie, Rodriguez Lizis O, Lacey Mitchel, Seetharamaiah Rupa
General Surgery, Florida International University, Herbert Wertheim College of Medicine, Miami, USA.
Surgery, Florida International University, Herbert Wertheim College of Medicine, Miami, USA.
Cureus. 2024 Feb 24;16(2):e54823. doi: 10.7759/cureus.54823. eCollection 2024 Feb.
Intussusception in adults is rare and is often associated with a pathologic lead point. While colonic adenocarcinoma is a common cause, well-differentiated colonic neuroendocrine tumors are exceedingly rare. We present a unique case of an ileocolic intussusception due to a distal ascending colonic neuroendocrine tumor, emphasizing the diagnostic challenges and importance of prompt intervention. A 60-year-old male with a previous screening colonoscopy in June of 2022 presented to the Emergency Department with two days of cramping, right upper abdominal pain with associated nausea and two episodes of emesis. A Computed Tomography (CT) scan of the abdomen and pelvis revealed an ileocolic intussusception noted at the level of the hepatic flexure with a lead point. Emergent surgical intervention identified a mass in the distal ascending colon, and a right hemicolectomy with successful side-to-side functional end-to-end anastomosis was performed. Final pathology confirmed a well-differentiated stage III colonic neuroendocrine tumor. After a successful postoperative recovery, a full body Positron Emission Tomography (PET) scan was completed and resulted in no evidence of avid metastatic disease. The patient was placed in cancer remission. Intussusceptions in the adult population are uncommon, and the etiology typically involves a pathologic lead point causing intestinal invagination. In this case, prompt diagnosis and management resulted in successful health outcomes with reduced mortality and morbidity, as untreated intussusception can have devastating results. Given this patient's colonoscopy was approximately one year ago, the probability of a colonic neoplasm acting as the lead point was low. However, identification of the intussusception resulted in a timely and lifesaving emergent right hemicolectomy, as this stage III tumor has a five-year median survival rate of only 50% if left untreated. This case report highlights a rare case of adult ileocolic intussusception involving a lead point at the distal ascending colon identified as an uncommon, well-differentiated stage III neuroendocrine tumor. It showcases the importance of considering intussusception as a diagnosis when evaluating adults with abdominal pain for prompt and adequate intervention, especially when malignant lead points and bowel necrosis are suspected.
成人肠套叠罕见，常与病理性引导点相关。虽然结肠腺癌是常见病因，但高分化结肠神经内分泌肿瘤极为罕见。我们报告一例因升结肠远端神经内分泌肿瘤导致的回结肠型肠套叠的独特病例，强调诊断挑战及及时干预的重要性。一名60岁男性，2022年6月曾接受结肠镜筛查，因两天来的绞痛、右上腹疼痛伴恶心及两次呕吐就诊于急诊科。腹部和盆腔计算机断层扫描（CT）显示肝曲水平存在回结肠型肠套叠并有引导点。紧急手术干预发现升结肠远端有一肿物，遂行右半结肠切除术并成功进行了侧侧功能性端端吻合。最终病理证实为高分化III期结肠神经内分泌肿瘤。术后成功恢复后，进行了全身正电子发射断层扫描（PET），结果显示无活跃转移病灶迹象。患者癌症缓解。成人肠套叠并不常见，其病因通常涉及导致肠套入的病理性引导点。在此病例中，及时诊断和处理带来了成功的健康结局，降低了死亡率和发病率，因为未经治疗的肠套叠可能产生灾难性后果。鉴于该患者的结肠镜检查约在一年前，结肠肿瘤作为引导点的可能性较低。然而，肠套叠的发现导致了及时且挽救生命的紧急右半结肠切除术，因为如果不治疗，这种III期肿瘤的五年中位生存率仅为50%。本病例报告突出了一例罕见的成人回结肠型肠套叠，其引导点位于升结肠远端，被确定为罕见的高分化III期神经内分泌肿瘤。它展示了在评估腹痛成人患者时将肠套叠作为诊断考虑以进行及时和充分干预的重要性，尤其是在怀疑有恶性引导点和肠坏死时。
