A rare case of sigmoid intussusception. A case report.

INTRODUCTION AND IMPORTANCE: Colorectal intussusception can be quite challenging to identify, especially its malignant nature. This is a fairly rare presentation and hence, there is not much associated research or cases reported in the literature. CASE PRESENTATION: We present a 69 year old male with lower abdominal pain and a significant rectal prolapse. He has a background history of heavy smoking and significant alcohol intake. The prolapse was irreducible and had papillomatous changes present on the prolapsed mucosa. A computerized tomography (CT) scan demonstrated a large rectal prolapse followed by a Magnetic Resonance Imaging (MRI) Pelvis which showed an intussusception at the S2-3 level, consistent with a carcinoma, The patient then proceeded to have a flexible sigmoidoscopy with a planned proceed to an anterior resection. Histopathology revealed sigmoid and descending colon adenocarcinoma with mucinous differentiation pT3N0. He had an unremarkable hospital stay and remained well on follow up. His case was discussed at the multidisciplinary meeting and was not for any adjuvant chemotherapy. CLINICAL DISCUSSION: Imaging can help aid early diagnosis of a colorectal intussusception. Colonoscopies can be useful too; however these can be tricky to diagnose pre-operatively. If there is a high suspicion of malignancy, routine resection is the preferred method of treatment in cases of colorectal intussusception. CONCLUSION: Although not a very common presentation, diagnosis of colorectal cancer presenting as an intussusception can be dealt with imminently by considering operative measures.

Necrotising fasciitis secondary to a perforated hepatic flexure tumour - A case report.

INTRODUCTION AND IMPORTANCE: Necrotising fasciitis caused by a perforated colon cancer is a very rare occurrence and can be very life threatening needing urgent intervention involving tissue salvage and oncological treatment. There is not enough evidence in the literature regarding management of the same. This case report highlights one such case along with management principles. PRESENTING CASE: We present a 66 year old male with 3 weeks of a progressive right lower quadrant lump and constitutional symptoms. He had a computed tomography scan demonstrating a complex collection in the right anterior abdominal wall, containing multiple locules of gas and air fluid levels near an abnormally thickened hepatic flexure. He was taken for an urgent debridement followed by laparotomy which demonstrated extensive abdominal wall necrotising fasciitis secondary to a perforated hepatic flexure tumour invading into the duodenum. He was given a diverting ileostomy. He had a relook laparotomy the next day for a right hemicolectomy and part of the duodenum resected with a refashioned end ileostomy. He was subsequently managed on the ward for two weeks and then discharged home. He remains well and has been referred to medical oncology for adjuvant chemotherapy. CLINICAL DISCUSSION: A two step surgical approach was key in this case, first step for source control and the second step focused on an oncological resection. CONCLUSION: This case explains the importance of excluding malignant causes of necrotising fasciitis. Perforated cancers can manifest as necrotising fasciitis and management should include timely debridement as well as oncological principles.

Small bowel intussusception: Does being transient make it less problematic? A case report.

INTRODUCTION: Small bowel intussusception is challenging to diagnose as it does not always declare itself. There is not enough evidence in the literature regarding the management of the same. This case report investigates relevant management options to ensure appropriate and timely treatment. PRESENTING CASE: We present a 75-year-old male with a six-week history of abdominal pain and constipation. He has a background history of hypercholesterolaemia, hypertension, asthma, and ex-smoking. He had normal inflammatory markers and an abdominal computerised tomography scan demonstrating dilated jejunal loops with an abrupt transition in the mid-abdomen caused by a short intussusception, with a lead point suggestive of a small mucosal mass. He underwent a diagnostic laparoscopy, which did not demonstrate any obstruction or mass. He had an unremarkable hospital stay and was then discharged home. He remained well on outpatient follow-up. CONCLUSION: This case highlights the transient nature of some small bowel intussusception. If there are enough signs suggesting the pathological nature of presentation on imaging, surgical intervention can be sought.