Anish Iyer, DO1, Anjo Chacko, MD2, Pedrito Perez, MD1, David Del Sol, MD1 1Broward Health North, Deerfield Beach, FL; 2Broward Health North, Coral Springs, FL Introduction: This report presents a unique case of ileocolic intussusception in a healthy 37-year-old male, caused by a large tubulovillous adenoma, highlighting the importance of early diagnosis and surgical intervention.
Case Description/
Methods: A 37-year-old male with no past medical history presented to the ED with 2 weeks of intermittent right lower and middle quadrant abdominal pain associated with nausea, non-bloody nonbilious emesis, and loose stools. He denied fever, chills, melena, hematochezia, dysuria, hematemesis, or weight loss. Physical exam was notable for tender mass in the right periumbilical region. Laboratory tests revealed mild leukocytosis. Abdominal CT showed a large right lower quadrant mass measuring approximately 11 cm in length and 6 cm in width, extending into the pelvis and involving the right colon. It showed characteristics of bowel tissue and displayed the radiographic "donut sign," suggesting ileocolic intussusception. No signs of obstruction, free air, or free fluid were observed. The patient underwent exploratory laparotomy, ileum noted to have intussusception into the cecum with no overlying erythema, no signs of ischemia, no bloody or red inflammatory fluid. Ileum was reduced from the cecum by placing gentle pulsion at the cecum. Cecal mass was noted causing scarring of the base of the cecum. Histopathological of the ileocecectomy confirmed a 6.5 × 4.0 × 2.0 cm tubulovillous adenoma with low-grade dysplasia. It extended into the submucosa without invading the muscularis. Multiple lymph node biopsies showed no evidence of malignancy. Postoperatively, the patient had an uneventful recovery and was discharged on day 6. Follow-up at six months revealed no recurrence, and a surveillance colonoscopy was scheduled. Discussion: Adult intussusception is a rare condition, accounting for 5% of all intussusception cases and 1-5% of bowel obstructions. Unlike the pediatric form, which is idiopathic, a pathological lead point can be identified in most adult intussusception. These lead points are often benign or malignant tumors. Benign lesions are less common than malignancies but can lead to significant complications if left untreated. CT imaging is important to diagnose due to its high sensitivity and specificity for identifying intussusception and its lead point. This case underscores the importance of considering intussusception in the differential diagnosis of nonspecific abdominal symptoms in adults.
Disclosures: Anish Iyer indicated no relevant financial relationships. Anjo Chacko indicated no relevant financial relationships. Pedrito Perez indicated no relevant financial relationships. David Del Sol indicated no relevant financial relationships.
Anish Iyer, DO1, Anjo Chacko, MD2, Pedrito Perez, MD1, David Del Sol, MD1. P1978 - Ileocolic Intussusception Due to a Tubulovillous Adenoma in a Healthy 37-Year-Old Male, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
