COINCIDENTAL ASCENDING COLON MALIGNANT INTUSSUSCEPTION IN A KNOWN

COINCIDENTAL ASCENDING COLON MALIGNANT INTUSSUSCEPTION IN A KNOWN CASE OF SMALL BOWEL CROHN’S DISEASE Dr. Nawal Al Khafagi Dr. Hossam Mahrous Croydon University Hospital

synopsis and final diagnosis A 76 years old lady with known Crohn’s disease , diagnosed 5 years ago and well controlled on azathioprine, was presented with severe right abdominal pain , nausea and vomiting. She suffered from reduced appetite and progressive weight loss. She also had episodes of watery diarrhea with no mucous or blood. Her surgical history was remarkable for hysterectomy and cholecystectomy. On examination she had tenderness over the suprapubic region, umbilical region and right iliac fossa. Her vital signs were unremarkable. Blood tests revealed longstanding lymphopenia and other blood tests were within normal limits. Initial diagnosis was an attack of active Crohn’s disease. Routine enhanced CT scan was requested to assess the activity and the extent of the inflammatory process. CT scan revealed features of chronic inflammatory changes and thickening of the terminal ileum. The coincidental finding was a polypoidal ascending colon tumor which together with the irregular wall thickening and shouldering causing colo-colic intussusception. Pericolic fat stranding and lymph nodes also noted. Doughnut appearance in axial images and Mushroom shape in coronal images were seen and there was no duodenal involvement or liver metastasis. The findings were discussed in the surgical/oncology MDT and right hemicolectomy and ileo-colostomy formation were performed. Histopathology results confirmed the diagnosis of moderately differentiated adenocarcinoma of the ascending colon (T 3 N 2 MX) according to the TNM 8 th edition, the number of lymph nodes involved was 7/27. She was given chemotherapy cycles in addition to her usual treatment to prevent recurrence.

Wall irregularity and Pericolic stranding Malignant intussusception Mushroom shape LN Intussusception Doughnut shape Shouldering Terminal ileum