Caecal endometriosis causing colo-colic intussusception: a rare cause of bowel obstruction

P. Thangamani, K. Senthil Kumar, M. Sivan, S. P. Sushmitha
In: International Surgery Journal · 2022 · vol. 10(1) , pp. 157 · doi:10.18203/2349-2902.isj20223610 · W4313395326
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This case report describes a rare instance of colo-colic intussusception caused by a caecal endometriosis in a 45-year-old female presenting with bowel obstruction.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-12 · read from full text ⓘ

This case report describes a 45-year-old menstruating woman with 10 days of diffuse abdominal pain and vomiting, found on clinical exam and imaging to have caeco-colic intussusception involving the ascending colon and right two-thirds of the transverse colon without an obvious lead point. At emergency laparotomy, the caecum was telescoped into the ascending colon up to the hepatic flexure, and multiple black nodules were seen in the lateral pelvis, small bowel, omentum, and mesentery, with pelvic adhesions involving the uterus and rectum; a palpable caecal growth prompted right hemicolectomy with ileocolic end-to-side anastomosis. Postoperative histopathology identified endometriosis of the caecum, and the authors note that clinical and radiological investigations are of limited help for diagnosing endometriosis in this setting. This paper is centrally about endometriosis — specifically caecal endometriosis acting as the lead point for adult caeco-colic intussusception causing bowel obstruction.

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Abstract

Intussusception refers to telescoping of a segment of bowel into adjacent bowel. Only 5% occurs in adults. Causes include neoplasm and inflammatory causes. Caecal endometriosis causing colo colic intussusception is extremely rare condition. A 45-year-old menstruating female presented with complaints of diffuse abdominal pain with vomiting for 10 days. No history of menstrual abnormalities. P/A-mass of 8×5 cm was palpable in right lumbar and umbilical region with mild tenderness. Cect abdomen-colo colic intussusception involving ascending colon and right 2/3rd of transverse colon with no obvious lead point. Patient was taken up for emergency laparotomy and it revealed 1) Intussusception of caecum into ascending colon extending upto hepatic flexure, 2) Multiple black colored nodules over lateral pelvic wall, small bowel, omentum, mesentery, ascending sigmoid colon, 3) Anterior surface of rectum was found to be adherent to posterior surface of uterus and pouch of Douglas inaccessible, 4) Multiple nodes were identified within mesentery. Laparotomy proceeded and gentle manual reduction of intussusceptum was done and growth palpable within caecum, suspecting the growth to be malignant right hemicolectomy with ileocolic end to side anastomosis done. Post operative period uneventful, HPE-endometriosis caecum. Intussusception in adult is rare entity and endometrial mass in caecum acting as lead point has been infrequently reported. Clinical and radiological investigations are of little help in diagnosing endometriosis. Hence, high clinical suspicion is required in patients with previous history of endometriosis.
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Caecal endometriosis causing colo-colic intussusception: a rare cause of bowel obstruction DOI: https://doi.org/10.18203/2349-2902.isj20223610Keywords: Endometriosis, Intussusception, Intussusceptum, Right hemicolectomy, Ileocolic anastomosisAbstract Intussusception refers to telescoping of a segment of bowel into adjacent bowel. Only 5% occurs in adults. Causes include neoplasm and inflammatory causes. Caecal endometriosis causing colo colic intussusception is extremely rare condition. A 45-year-old menstruating female presented with complaints of diffuse abdominal pain with vomiting for 10 days. No history of menstrual abnormalities. P/A-mass of 8×5 cm was palpable in right lumbar and umbilical region with mild tenderness. Cect abdomen-colo colic intussusception involving ascending colon and right 2/3rd of transverse colon with no obvious lead point. Patient was taken up for emergency laparotomy and it revealed 1) Intussusception of caecum into ascending colon extending upto hepatic flexure, 2) Multiple black colored nodules over lateral pelvic wall, small bowel, omentum, mesentery, ascending sigmoid colon, 3) Anterior surface of rectum was found to be adherent to posterior surface of uterus and pouch of Douglas inaccessible, 4) Multiple nodes were identified within mesentery. Laparotomy proceeded and gentle manual reduction of intussusceptum was done and growth palpable within caecum, suspecting the growth to be malignant right hemicolectomy with ileocolic end to side anastomosis done. Post operative period uneventful, HPE-endometriosis caecum. Intussusception in adult is rare entity and endometrial mass in caecum acting as lead point has been infrequently reported. Clinical and radiological investigations are of little help in diagnosing endometriosis. Hence, high clinical suspicion is required in patients with previous history of endometriosis. Metrics References Rivkine E, Marciano L, Polliand C, Valenti A, Ziol M, Barrat C et al. Ileocolic intussusception due to a cecal endometriosis: case report and review of literature. Diagn Pathol. 2012;7:62. Zubaidi A, Al-Saif F, Silverman R. Adult intussusception: a retrospective review. Dis Colon Rectum. 2006;49:1546-51. Rodriguez-Lopez M, Bailon-Cuadrado M, Tejero-Pintor FJ, Choolani E, Fernandez-Perez G, Tapia-Herrero A. Ileocecal intussusception extending to left colon due to endometriosis. Ann R Coll Surg Engl. 2018;100(3):e62-3. Eisen LK, Cunningham JD, Aufses AH Jr. Intussusception in Adults: Institutional Review. J Am Coll Surg. 1999;188(4):390-5. Biscaldi E, Ferrero S, Fulcheri E, Ragni N, Remorgida V, Rollandi GA. Multislice CT enteroclysis in the diagnosis of bowel endometriosis. Eur Radiol. 2007;17:211-9. Takeuchi H, Kuwatsuru R, Kitade M, Sakurai A, Kikuchi I, Shimanuki H et al. A novel technique using magnetic resonance imaging jelly for evaluation of rectovaginal endometriosis. Fertil Steril. 2005;83:442-7. Bedaiwy MA, Falcone T: Laboratory testing for endometriosis. Clin Chim Acta. 2004;340:41-56. Orbuch IK, Reich H, Orbuch M, Orbuch L. Laparoscopic treatment of recurrent small bowel obstruction secondary to ileal endometriosis. J Minim Invasive Gynecol. 2007;14:113-5. Lianos G, Xeropotamos N, Bali C, Baltogiannis G, Ignatiadou E. Adult bowel intussusception: presentation, location, etiology, diagnosis and treatment. G Chir. 2013;34(9-10):280-3. Hunter J. On introsusception (read Aug 18, 1789). In: Palmer JF, ed. The works of John Hunter, FRS London. London: Longman, Rees, Orme, Brown, Green, Longman. 1837;587-93. Marinis A, Yiallourou A, Samanides L, Dafnios N, Anastasopoulos G, Vassiliou I et al. Intussusception of the bowel in adults: A review. World J Gastroenterol. 2009;15(4):407-11. Hutchinson J. A successful case of abdominal section for intus- susception. Proc R Med Chir Soc. 1873;7:195-8. Weilbaecher D, Bolin JA, Hearn D, Ogden W, 2nd. Intussusception in adults. Review of 160 cases. Am J Surg. 1971;121:531-5. Akcay MN, Polat M, Cadirci M, Gencer B. Tumor-induced ileo-ileal invagination in adults. Am Surg. 1994;60:980-1. Tan KY, Tan SM, Tan AG, Chen CY, Chng HC, Hoe MN. Adult intussusception: experience in Singapore. ANZ J Surg. 2003;73:1044-7. Haas EM, Etter EL, Ellis S, Taylor TV. Adult intussusception. Am J Surg. 2003;186:75-6. Berel JS. Berek and Novak’s gynaecology, 16th edition. Wolters Kluwer India Pvt. Ltd. 2019. Wang N, Cui XY, Liu Y, Long J, Xu YH, Guo RX et al. Adult intussusception: A retrospective review of 41 cases. World J Gastroenterol. 2009;15(26):3303-8. Yeo CJ. Shackelford’s surgery of the alimentary tract 8th edition, Elsevier. 2018. Stubenord WT, Thorblamarson B. Intussusception in adults. Ann Surg. 1970;172:306-10. Nagorney DM, Sarr MG, McIlrath DC. Surgical management of intussusception in the adult. Ann Surg. 1981;193:230-6. Eisen LK, Cunningham JD, Aufses AH Jr. Intussusception in adults: institutional review. J Am Coll Surg. 1999;188:390-5. Barbiera F, Cusma S, Di Giacomo D. Adult intestinal intussusception: surgery-CT correlation. Radiol Med. 2001;102:37-42.

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