On
the CT abdomen, a segment of bowel loop was seen invaginated into its
proximal segment with bowel wall thickening in the ascending colon
extending to the transverse colon which confirmed the diagnosis of
colo-colic intussusception. Also, multiple gall stones were elicited by
the CT scan (Fig 1).
Chest x-ray and echocardiography were normal.
An elective laparotomy was scheduled two days after the presentation.
The patient was kept NPO with full fluid maintenance, antibiotic, PPI,
and prophylactic anticoagulant. An incision abdomen was opened through a
midline, and a large mass was found, including the terminal ileum, the
ileocecal valve, the appendix, the cecum and the ascending colon, which
were invaginated in the transverse colon. Adhesions were found between
the abdominal wall and the mass and were released. As colonic milking
was unsuccessful, it was decided to go for the right hemicolectomy and
end-to-end anastomosis (Fig 2). Cut section of the cecum showed
fungating mass of 6×5×3 cm (Fig 3).