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Intussusception caused by an inverted colonic diverticulum: a case report
© The Author(s). 2018
Received: 20 September 2017
Accepted: 9 March 2018
Published: 27 April 2018
Intussusception is an unusual disorder among the complications of diverticula in adults. This study aimed to report intussusception due to an inverted colonic diverticulum. Such a large inverted colonic diverticulum has rarely been reported.
A 62-year-old Chinese woman presented to the First Hospital of Jilin University with abdominal pain, vomiting, and bloody stool. Preoperative computed tomography imaging indicated intussusception. The intraoperative diagnosis was consistent with postoperative pathology. Our patient was diagnosed as having an inverted colonic diverticulum near the ileocecal valve with intussusception and intestinal necrosis.
Although inverted colonic diverticulum is extremely rare, it should also be considered among the causative factors of intussusception.
Colonic diverticulum seldom has clinical symptoms . When colonic diverticulum is associated with complications, surgical treatment may be considered . Intussusception is one of the emergency situations. Among the most reported complications, intussusception was described occasionally, but an inverted colonic diverticulum (ICD) as large as the one reported in the present study has rarely been described. The correct preoperative diagnosis of intussusception due to ICD has rarely been made . This study aimed to present the case of an ICD complicated by ileocolonic intussusception in a Chinese elderly woman successfully treated surgically.
Complete blood count before and after surgery
First day after surgery
Second day after surgery
Red blood cell (RBC)
Mean corpuscular volume (MCV)
Mean corpuscular hemoglobin (MCH)
Mean corpuscular hemoglobin concentration (MCHC)
White blood cell (WBC)
Neutrophil count (NE)
Lymphocyte count (LY)
Monocyte count (MO)
Eosinophil count (EO)
Neutrophil percentage (NE%)
Lymphocyte percentage (LY%)
Monocyte percentage (MO%)
Eosinophil percentage (EO%)
Blood biochemical examination
First day after surgery
Alanine aminotransferase (ALT)
Alkaline phosphatase (ALP)
Total protein (TP)
Total bilirubin in serum (TBIL)
Direct bilirubin in serum (DBIL)
Indirect bilirubin in serum (IBIL)
Blood urea nitrogen (BUN)
Serum creatinine (Cr)
Cefmenoxime hydrochloride injection (2 g) was used before and after the surgery to prevent infection. Our patient quickly recovered and was discharged 7 days after the surgery without any complications. She had a telephonic follow-up 10 months after discharge from our hospital. She had no apparent symptoms after the surgery. Serological and imaging examinations were performed in a local hospital, and the results were negative.
Colonic diverticular disease is a common condition. However, it has become increasingly difficult to ignore a singular relatively large diverticulum. A previous study reported giant ascending colonic diverticulum with intussusception . The diameter of the diverticulum described in that report was larger than 4 cm, but the diverticulum in the present study was not as large as that giant colonic diverticulum. In the present study, intussusception was caused by an ICD with a diameter of 3.8 cm.
Intussusception refers to the insertion of an intestinal tube into the contiguous lumen, usually leading to intestinal obstruction and ischemia . Intussusception in adults accounts for 1–3% of intestinal obstruction in adults . The etiology of more than 90% of adult intussusceptions has been reported . However, the preoperative diagnosis of adult intussusception still remains difficult. Abdominal CT is usually used in the preoperative evaluation. Surgery is the recommended treatment.
ICD is rare. The incidence rate of ICD is approximately 0.7% . The smaller ICD tends to be indistinguishable from colonic polyps. Endoscopic biopsy or polypectomy can be dangerous in such a situation . The water jet deformation sign is thought to be a safer and more reliable method compared with biopsy forceps and air insufflation . The differential diagnosis includes cecal volvulus, a duplication cyst or giant Meckel diverticulum, and pneumatosis cystoides intestinalis.
The lesion in the patient in this study was unusual. It occurred in the colon close to the ileocecal valve. The diameter was 3.8 cm, not larger than 4.0 cm, and the lesion was not located in the sigmoid colon. It could not be defined as a giant colonic diverticulum because the diameter of a giant colonic diverticulum needs to be larger than 4 cm, more often occurring in the sigmoid colon . The mechanism of the formation of large diverticula is not fully known. One possibility is the ball-valve mechanism. A narrow passage between the normal bowel and the diverticulum makes the diverticulum larger . Although the size of the lesion reported in this study did not reach 4.0 cm, the evolutionary process of a giant colonic diverticulum could not be excluded. Any intestinal condition that changes the normal pattern of peristalsis increases the risk of intussusception. Colonic diverticulum as a rare cause of adult intussusception was shown in this study. A previous study retrospectively reviewed 16 years of data from patients with intussusception and found that 77.3% of cases were related to a tumor, 73.5% of which were malignant. Among these, 11.3% occurred in a postoperative setting and 11.3% were idiopathic . The intussusception due to ICD in the present case is a rare event in adult patients. Although the exact mechanism of invagination is unknown in this case, it is speculated that the existence of colonic diverticulum caused abnormal peristalsis of the intestines. Furthermore, the diameter of the diverticulum was relatively large in size.
A previous study reported intussusception caused by a giant colonic diverticulum. A laparoscopic right hemicolectomy was performed for one-stage treatment . Roch et al. reported that laparoscopic atypical colon wedge resection was safely performed, and it might be considered an alternative for extended resections of giant diverticula .
Although such a large ICD is extremely rare, it should also be considered among the causative factors of intussusception.
Availability of data and materials
BZ was a major contributor in writing the manuscript and interpreting the CT imaging. HY recorded intraoperative condition and performed the physical examination. JW and XL helped modify the manuscript. All authors read and approved the final manuscript.
Ethics approval and consent to participate
Ethical approval was obtained from the First Hospital of Jilin University Research Ethics Committee. The patient gave written informed consent to participate in this study.
Consent for publication
Written informed consent was obtained from the patient for publication of this report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
The authors declare that they have no competing interests.
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