Right Lower Quadrant Pain



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For 3 days, a 69-year-old man had had intermittent colicky pain on the right side of the abdomen, loose bowel movements, and a low-grade fever. Examination disclosed a mildly tender, palpable, diffuse mass in the right upper quadrant and hyperactive bowel sounds. The patient’s stool was positive for occult blood, and a complete blood cell count showed a low hemoglobin level and a slightly elevated white blood cell count. CT revealed a mass with concentric rings of bowel gas, bowel wall, and intraluminal fluid—the typical targetlike appearance of colonic intussusception.

At laparotomy, cecocolic intussusception was found, and resection was performed. The photo of the surgical specimen shows the cecal tumor that served as a lead point for intussusception. Microscopic examination of the mass revealed a well-differentiated adenocarcinoma.

Intussusception accounts for 5% of all cases of bowel obstruction, writes Dr Virendra A. Parikh of Fort Wayne, Ind. The majority of these occur in infants under age 2, are generally idiopathic, and can usually be reduced by hydrostatic pressure. Among adults, intussusception is usually secondary to a benign or malignant tumor. When the colon is involved, the condition is best managed by resection of the involved portion because of the frequent association with colonic neoplasms. 

 

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