Adult transverse colon intussusception: A case report and literature review

Abstract

Intussusception of the transverse colon in adults is commonly associated with a malignant lead point. Timely diagnosis and surgery are particularly important in weak patients with many comorbidities. An 84-year-old man presented with a 5-day history of vomiting, abdominal distension, and generalized weakness. He had severe frailty (Clinical Frailty Scale [CFS] score 7) and multiple comorbidities including Parkinson’s disease, hypertension, chronic kidney disease, and anemia. Laboratory investigations revealed metabolic acidosis, leukocytosis, and acute kidney injury. Contrast-enhanced CT of the abdomen and pelvis demonstrated bowel obstruction with pneumoperitoneum; however, perforation and an underlying malignant lead point were not identified on imaging. Emergency laparotomy revealed a perforated transverse colon intussusception with a 5 × 5 cm mucinous adenocarcinoma as the lead point. Palliative transverse colectomy with end ileostomy was performed owing to hemodynamic instability. Postoperatively, the patient developed hypoactive delirium, Parkinson-related rigidity attributable to the inability to administer oral dopaminergic medication preoperatively and a delay in initiating the transdermal rotigotine patch postoperatively, hypoglycemia, and sepsis. Despite intensive care support, his condition deteriorated and he died on postoperative day 12. This case highlights the limitations of preoperative CT imaging in identifying perforation and malignancy in colonic intussusception, the complexity of perioperative management in frail patients with multiple comorbidities, and the importance of early multidisciplinary decision-making in geriatric surgical emergencies.