Ileocolic intussusception due to caecum cancer in very young male: a rather difficult diagnosis
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Ileocolic Intussusception Due to Caecum Cancer in Very Young Male: a Rather Difficult Diagnosis Case Report Α. C. Datsis, C. J. Anagnostopoulos, A. Rogdakis, A. Vaxevanidou, S. P. Kekelos, J. D. Spiliotis Received 03/06/2011 Accepted 27/06/2011
Abstract Aim-Background: The aim of our study was to describe a case of ileocolic intussusception due to caecum cancer in a very young patient and the difficulties in the diagnosis. Material-Method: The history concerned a 26-yearold male with transient abdominal pain and mild diarrhoea for the previous 7 days before admission. Poor physical and laboratory findings along with an amelioration of his symptoms without any specific treatment resulted in the delay of the correct diagnosis. After a recurrence of the symptoms, we proceeded to perform abdominal computed tomography which revealed an ileocolic intussusception. Results: The patient underwent a right hemicolectomy and one-stage anastomosis for caecum adenocarcinoma. Three years after surgery, the patient displays a slight elevation in CEA and CA19.9 values without evidence of recurrence on computed tomography. Conclusion: Intussusception is a rare entity among the young population and rather difficult to diagnose without a high level of suspicion. The gold standard for the preoperative diagnosis is abdominal computed tomography. The operative strategy should include an oncological bowel resection without extensive manoeuvres for manual reduction.
Key words
Caecum cancer, Ileocolic intussusception, Diagnosis
Introduction In 2007, colon cancer accounted for 44.6 new cases per 100.000 in the USA, with a mortality of 16.7 per 100.000 [1]. The caecum is the involved site in about 7% of these cases, only 1.1% of which concerns
A. C. Datsis (Corresponding author), C. J. Anagnostopoulos, A. Rogdakis, S. P. Kekelos, J. D. Spiliotis - Surgical Clinic A. Vaxevanidou - Anesthesiology department Messolonghi General Hospital “Hatzikosta”, Messolonghi, Greece e-mail: [email protected]
young patients [2]. The presenting symptoms are indefinite, usually mild abdominal pain and anaemia [3]. Intussusception is a rare premiere symptom for caecum cancer, seen more often during childhood, and it is equally rare among young males, rendering diagnosis difficult [4]. Herein, we describe such a case of a young man with caecum adenocarcinoma presenting as ileocolic intussusception.
Case report A 26-year-old male presented at our emergency department with a history of transient abdominal pain and mild diarrhoea that had begun 7 days prior to presentation. He reported that the pain had exacerbated two hours earlier. Physical examination was unremarkable with the exception of mild tenderness in the right lower quadrant with no guarding or rebound tenderness. An anorectal examination was negative for blood. His laboratory examination revealed anaemia (haematocrit 33,5%) and mild leucocytosis. Plain abdominal x-rays showed one or two air-fluid levels. The abdominal ultrasound revealed a small quantity of free fluid in the abdominal cavity. He w
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