Cecocolic Intussusception in Adult Caused by Acute Appendicitis

Intussusception in adult is rare. The etiology is different from that of childhood. The most common cause of intussusception in adult is known as malignancy. When dealing with adult intussusception, surgical resection is usually warranted for correct diagnosis and proper treatment. This is a case report of cecocolic intussusception caused by an acute appendicitis in adult. The causes of cecocolic intussusception were reported as appendiceal adenocarcinoma, appendiceal mucocele, appendiceal adenoma, or idiopathic. Although this patient underwent laparoscopic right hemicolectomy under suspicion of malignancy at cecum base, final pathologic diagnosis revealed only acute appendicitis. Thus, the present case emphasizes the importance of prior thorough examinations including colonoscopy when we encounter this rare kind of intussusception in adult. 1. Introduction Intussusception occurs when one segment of bowel and associated mesentery invaginated into an adjacent segment [1]. Intussusception is primarily a childhood disease. Adult intussusception is a rare clinical entity accounting for 5% of all intussusceptions [1]. It was reported that 63% of the adult intussusception was related to the tumor [2]. Because of the high risk of malignancy, definitive surgical resection is the recommended treatment in nearly all cases in adult intussusception [2]. Among various kinds of intussusception in adult, cecocolic intussusception was rare. Although appendiceal adenocarcinoma, adenoma, or mucocele could cause cecocolic intussusception, acute appendicitis was rarely reported as a leading cause of cecocolic intussusception. We report a case of cecocolic intussusception caused by an acute appendicitis treated by laparoscopic right hemicolectomy. 2. Case Presentation In February, 2013, a 73-year-old woman presented to our emergency department with right lower abdominal pain which began 2 days prior to admission. She had no relevant medical or surgical history. Pain was a maximum of 5 on the visual analogue scale. Routine blood tests showed mild elevated C-reactive protein and white blood cell counts were within the normal range. Abdominal computed tomography (CT) scan revealed invagination of the cecum and appendix into the lumen of the ascending colon. Mural thickening and enhancement of the dilated appendix up to 1？cm with a few appendicoliths in the invaginated large bowel were also noted (Figure 1). Figure 1: Abdominal computed tomography. Transverse (a) and coronal (b) views revealed invagination of the caecum and the appendix into the lumen of the ascending colon, as