EP 232 A Rare Case of Ileocolic Intussusception Masquerading as Rectal Prolapse

Background

Adult intussusception is unusual and occurs in the large bowel particularly in the right colon. Majority of the cases are associated with a pathology such as malignancy or benign mass. We are presenting a rare case of ileoocolic intussusception presenting as rectal prolapse.

Case Description

85 year old female presented with new onset rectal prolapse and PR bleeding. Despite the successful initial attempts to reduce the prolapse, eventually it became irreducible, and the mucosa started to become oedematous and necrotic so the decision was taken to proceed with Althemier’s procedure.

During surgery, the appendix was seen and two lumen could be appreciated, suggesting that the caecum had prolapsed. Laparotomy was started and it was found that the whole right colon and the transverse colon had been intussuscepted in the left colon causing the caecum to prolapse through the anus.

Discussion

Rectal prolapse secondary to ileocolic intussusception is rarely reported in literature. A cause was not identified in this patient. The main clinical sign is the presence of a second lumen, indicating the TI. Management of these cases can be difficult and controversial. CT abdomen and pelvis has a high sensitivity in diagnosing such cases and is required preoperatively to diagnose any leading cause and help plan the surgery.

Conclusion

Ileocolic intussusception with anal protrusion is a rare condition and difficult to diagnose. It can be mistaken as rectal prolapse. Awareness of this possibility should always be in the mind of the colorectal surgeon operating on an emergency rectal prolapse.