School of Medicine Publications and Presentations

S3764 Rectosigmoid Intussusception Presenting With Rectal Bleeding: An Extremely Rare Cause of Acute Lower Gastrointestinal Bleeding in an Elderly Patient

Document Type

Article

Publication Date

10-2024

Abstract

Introduction:

Intussusception is rarely found in the elderly population. An Intussusception at therectosigmoid junction with acute Gastrointestinal (GI) bleeding is exceedingly rare and has never been reported in the literature. Herein, we are presenting rectosigmoid intussusception, an unusual cause of acute lower GI bleeding in elderly patients.

Case Description/Methods:

An 88-year-old Hispanic male with a medical history of home hospice (revoked before thevisit) due to Chronic Obstructive Pulmonary Disease (COPD) was brought to the Emergency department due to bilateral lower quadrant abdominal pain and frank blood per rectum for the last two days. The physical examination was unremarkable except for tachypnea with a respiratory rate of 28 and suprapubic tenderness. The per-rectal examination was positive for frank blood. Laboratory investigations were within normal limits except for a white cell count of 17, hemoglobin of 10.1, and Mean corpuscular volume of 80. Ammonia was less than 14. The International Normalized Ratio (INR) was 1.02. Hemoglobin dropped from 10.1 to 8.0 on the following day. He was replaced by one unit packed with red blood cells. A Computed Tomography (CT) Abdomen Pelvis Angiogram with contrast showed bull's eye sign at rectosigmoid junction consistent with intussusception. There was no proximal dilation noted. He underwent a flexible sigmoidoscopy and showed congested bowel, ischemia, frank blood, and intussusception at the rectosigmoid junction. General Surgery was consulted, and an exploratory laparotomy was performed. He was found to have rectosigmoid intussusception, and the affected rectosigmoid section was resected. He was sent back home to hospice due to advanced COPD.

Discussion:

Intussusception presents very vague symptoms in elderly patients as compared to theyoung population. It can complicate rapidly such as bowel obstruction, ischemia, hematochezia, or rectal prolapse if not treated promptly. The most common lead point for intussusception in the elderly is malignancy followed by colonic polyps and adhesions. Intussusception requires an exploratory laparotomy with resection of necrotic tissue and correction of a lead point defect (see Figure 1). https://images.journals.lww.com/ajg/Original.00000434-202410001-03765.F1.jpeg

Comments

© 2024 by The American College of Gastroenterology

Publication Title

The American Journal of Gastroenterology

DOI

http://doi.org/10.14309/01.ajg.0001044424.87614.45

Academic Level

faculty

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