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).