S6027 Ileocolic Intussusception Due To a Tubulovillous Adenoma in a Healthy 37-Year-Old Man

Introduction: This report presents a unique case of ileocolic intussusception in a healthy 37-year-old man, caused by a large tubulovillous adenoma, highlighting the importance of early diagnosis and surgical intervention. Case Description/Methods: A 37-year-old man with no past medical history presented to the emergency department 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 computed tomography 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 6 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. Computed tomography 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.