Faisal Mehmood, MD1, Hajra Jamil, MD2, Shreya Amin, MD1, Mehul Patel, DO3, Joseph Fares, MD4, Christopher Stasik, DO1, Gavin Levinthal, MD4 1HonorHealth, Phoenix, AZ; 2Services Institute of Medical Sciences, Lahore, Punjab, Pakistan; 3Honor Health Gastroenterology, Phoenix, AZ; 4HonorHealth, Scottsdale, AZ
Introduction: Intussusception after colonoscopy is an extremely rare complication. Management is conservative, however, in rare circumstances, surgery may be needed. We present a case of an elderly man who underwent a colonoscopy with polypectomy which was complicated by intussusception requiring surgery.
Case Description/Methods: A 71-year-old male presented to the hospital for fever, chills, generalized abdominal pain, and hematochezia for one day. Past medical history was remarkable for ulcerative colitis for which he recently underwent a colonoscopy with polypectomy of 19mm polyp in ascending colon one day before presentation. He was taking aspirin for secondary prophylaxis for stroke and was not taking NSAIDs, other antiplatelets, or anticoagulants.
He was febrile to 102.2 F. Labs showed leukocytosis 20800/uL, mild normocytic anemia with hemoglobin of 11.4 g/dL, normal platelet count, and INR. Blood chemistries showed hyponatremia of 129 mmol/L, hypokalemia of 3.1 mmol/L, and normal liver tests. He underwent CTA abdomen & pelvis and was noted to have a 6.5 x 6.8 cm mass representing hematoma from the recent biopsy site in the hepatic flexure of the colon causing colo-colonic intussusception (Figures A and B). There was no perforation or pneumatosis.
He was seen by colorectal surgery and underwent a right hemicolectomy. Later on, blood cultures grew E. coli and was treated with IV antibiotics. He tolerated the procedure and was discharged home. He was doing well on the follow-up office visit. Pathology of the resected right colon showed mucosal and submucosal necrosis with marked neutrophilic exudate extending into muscularis propria suggestive of intussusception (Figure C).
Discussion: Possible mechanisms for intussusception include a vacuum effect from aspiration of gas and retrieval of the colonoscope. It has been hypothesized that sites of biopsy and polypectomy serve as trigger points for colonic intussusception. Only nine cases of colo-colonic intussusception after colonoscopy have been reported and one of those cases required surgery for management. This will be the second case of colonic intussusception requiring hemicolectomy.
References:
Ligato I, Ruffa A, Sbarigia C, Petrucciani N, Esposito G (2024) Surprising Complication of Intussusception after Colonoscopy: A Case Report and A Review of the Literature. J Surg 9: 1981 DOI: 10.29011/2575-9760.001981
Figure: (A) Coronal image of CT abdomen and pelvis with IV contrast showing colo-colonic intussusception (blue arrow). (B) Axial image of CT abdomen and pelvis with IV contrast showing colo-colonic intussusception (blue arrow) (C) High power H & E demonstrating mucosal and submucosal necrosis with marked neutrophilic exudate extending into muscularis propria suggestive of intussusception.
Disclosures:
Faisal Mehmood indicated no relevant financial relationships.
Hajra Jamil indicated no relevant financial relationships.
Shreya Amin indicated no relevant financial relationships.
Mehul Patel indicated no relevant financial relationships.
Joseph Fares indicated no relevant financial relationships.
Christopher Stasik indicated no relevant financial relationships.
Gavin Levinthal indicated no relevant financial relationships.
Faisal Mehmood, MD1, Hajra Jamil, MD2, Shreya Amin, MD1, Mehul Patel, DO3, Joseph Fares, MD4, Christopher Stasik, DO1, Gavin Levinthal, MD4. P2011 - Colonic Intussusception: A Rare Complication After Colonoscopy, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
