Adult Rectosigmoid Junction Intussusception Presenting with Rectal Prolapse

Published in Singapore Medical Journal in May 2015

Du Jing Zeng, MBBS
Li Tserng Teo, FRCSE, FAMS
Chiu Ming Terk, FRCS, FAMS
Department of General Surgery, Tan Tock Seng Hospital, Singapore

Abstract:

Most cases of intussusception in adults present with chronic and nonspecific symptoms, and can sometimes be challenging to diagnose. We herein report on a patient with the rare symptom of colonic intussusceptions presenting with rectal prolapse and review the existing literature of similar case reports to discuss how to reach an accurate diagnosis. A 75-year-old woman with dementia presented with per rectal bleeding, rectal prolapse and lower abdominal pain. An operation was scheduled and a large sigmoid intussusception with a polyp as a leading point was found intraoperatively. She subsequently recovered well and was discharged. As large sigmoid intussusceptions may present as rectal prolapse,intussusception should be considered as a differential diagnosis for immobile patients, especially when the leading point is a lesion.

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References

  1. Yakan S, Caliskan C, Makay O, Denecli AG, Korkut MA. Intussusception
    in adults: clinical characteristics, diagnosis and operative strategies. World
    J Gastroenterol 2009; 15:1985-9.
  2. Wang N, Cui XY, Liu Y, et al. Adult intussusception: a retrospective review
    of 41 cases. World J Gastroenterol 2009; 15:3303-8.
  3. Greif F, Burstein Y, Hammer B. Burkitt’s lymphoma protruding through
    the anus. Report of an unusual case. Dis Colon Rectum 1988; 31:629-31.
  4. Younes ZH, Johnson DA, Dimick L. Sigmoido-anal intussusception
    presenting as rectal prolapse: role of endoscopic diagnosis. Gastrointest
    Endosc 1998; 47:561-3.
  5. Abantanga FA. Ileal invagination of the sigmoid colon producing a sigmoidorectal intussusception combined with rectal prolapse in a 3-year old child. Pediatr Surg Int 2005; 21:400-2.
  6. Tennant S, Halliday K. Intussusception mimicking rectal prolapse. Pediatr
    Radiol 2008; 38:700-2.
  7. Chen CW, Hsiao CW, Wu CC, et al. Rectal prolapse as initial clinical
    manifestation of colon cancer. Z Gastroenterol 2008; 46:348-50.
  8. Chen R, Zhao H, Sang X, et al. Severe adult ileosigmoid intussusception
    prolapsing from the rectum: A case report. Cases J 2008; 1:198.
  9. Roy J, Gouda M, Reddy BS, Baker RP. Sigmoid intussusception presenting as rectal prolapse in an adult. Colorectal Dis 2011; 13:e385.
  10. Teyha PS, Chandika A, Kotecha VR. Prolapsed sigmoid intussusception
    per anus in an elderly man: a case report. J Med Case Rep 2011; 5:389.
  11. Dvorkin LS, Knowles CH, Scott SM, et al. Rectal intussusception:
    characterization of symptomatology. Dis Colon Rectum 2005; 48:824-31.
  12. Marinis A, Yiallourou A, Samanides L, et al. Intussusception of the bowel
    in adults: a review. World J Gastroenterol 2009; 15:407-11.
  13. Takeuchi K, Tsuzuki Y, Ando T, et al. The diagnosis and treatment of adult
    intussusception. J Clin Gastroenterol 2003; 36:18-21.
  14. Tan KY, Tan SM, Tan AG, et al. Adult intussusception: experience in
    Singapore. ANZ J Surg 2003; 73:1044-7.