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Right colonic intussusception
IMAGE IN CLINICAL SURGERY
Right Colonic Intussusception James Laredo, MD, PhD, Boston, Massachusetts, Horst S. Filtzer, MD, Cambridge, Massachusetts
Figure 1.
A
46-year-old woman without prior abdominal surgery presented to the emergency room with 7 days of crampy, low abdominal pain that had worsened over the past 48 hours. She was afebrile and her physical examination revealed moderate tenderness in the right lower quadrant without guarding or rebound. Laboratory data were negative. An abdominal computed tomography scan with oral and intravenous contrast revealed an intestinal obstruction caused by a right colonic intussusception (Figure 1). A target lesion consistent with an intussusception (arrow) is present in the right colon. A concentric
Am J Surg. 2000;179:485. From the Department of Surgery (JL), Beth Israel Deaconess Medical Center, Boston, Massachusetts, and the Department of Surgery (HSF), Cambridge Hospital, Cambridge, Massachusetts.
© 2000 by Excerpta Medica, Inc. All rights reserved.
Figure 2.
ring of intraluminal mesenteric fat interposed between the central portion (intussusceptum) and the outer edematous colonic wall (intussuscipiens) gives this lesion its characteristic appearance. In addition, a fluid-filled proximal right colon (large arrowhead) and dilated loops of fluid-filled small bowel (small arrowheads) are also present. The patient was taken to the operating room where a firm, intraluminal right colonic mass was palpated around the area of the intussusception. A formal right colectomy was performed, and the specimen is shown in Figure 2. The cecum is to the right, and the area of intussusception is evident in the middle portion of the specimen. A 3.8 cm fungating polypoid tumor was found to be the lead point. Pathologic examination revealed a moderately differentiated adenocarcinoma with invasion into the muscularis propria. All eight lymph nodes in the surgical specimen were negative. The patient had an uneventful recovery.
0002-9610/00/$–see front matter PII S0002-9610(00)00389-5
485
Right Colonic Intussusception James Laredo, MD, PhD, Boston, Massachusetts, Horst S. Filtzer, MD, Cambridge, Massachusetts
Figure 1.
A
46-year-old woman without prior abdominal surgery presented to the emergency room with 7 days of crampy, low abdominal pain that had worsened over the past 48 hours. She was afebrile and her physical examination revealed moderate tenderness in the right lower quadrant without guarding or rebound. Laboratory data were negative. An abdominal computed tomography scan with oral and intravenous contrast revealed an intestinal obstruction caused by a right colonic intussusception (Figure 1). A target lesion consistent with an intussusception (arrow) is present in the right colon. A concentric
Am J Surg. 2000;179:485. From the Department of Surgery (JL), Beth Israel Deaconess Medical Center, Boston, Massachusetts, and the Department of Surgery (HSF), Cambridge Hospital, Cambridge, Massachusetts.
© 2000 by Excerpta Medica, Inc. All rights reserved.
Figure 2.
ring of intraluminal mesenteric fat interposed between the central portion (intussusceptum) and the outer edematous colonic wall (intussuscipiens) gives this lesion its characteristic appearance. In addition, a fluid-filled proximal right colon (large arrowhead) and dilated loops of fluid-filled small bowel (small arrowheads) are also present. The patient was taken to the operating room where a firm, intraluminal right colonic mass was palpated around the area of the intussusception. A formal right colectomy was performed, and the specimen is shown in Figure 2. The cecum is to the right, and the area of intussusception is evident in the middle portion of the specimen. A 3.8 cm fungating polypoid tumor was found to be the lead point. Pathologic examination revealed a moderately differentiated adenocarcinoma with invasion into the muscularis propria. All eight lymph nodes in the surgical specimen were negative. The patient had an uneventful recovery.
0002-9610/00/$–see front matter PII S0002-9610(00)00389-5
485