Colonic intussusception after endoscopic volvulus decompression
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KeywordsPeritonitis Intussusception Symptomatic Improvement Nonoperative Treatment Normal Blood Pressure
A 44-year old man came to the emergency department in April 2014 because of acute abdominal pain and vomiting starting the day before. He had a history of two episodes of intestinal occlusion due to sigmoid volvulus in 2012. He was not taking any medications or had other relevant medical issues. On admission, he was without fever, with normal blood pressure and heart rate, but with a very distended and painful abdomen. Blood analysis showed mild leukocytosis and elevated C-reactive protein (65 mg/L). Abdominal X-ray showed a distended colon with features compatible with a volvulus.
In the colonoscopy, we successfully passed trough the volvulus, and a very distended colon with hard stools was seen proximally. Upon retrieval of the scope, we decompressed the colon but unexpectedly, a spontaneous intussusception occurred, which was successfully reduced with the scope, with no adverse events. The patient referred a considerably symptomatic improvement after the procedure. He was advised of the need of a total colonoscopy to exclude neoplastic lesions and of the possible complications of a colonic volvulus, namely perforation and sepsis.
Despite the successful management of these situations by colonoscopy, with good results in up to 80 % of the patients  or even higher , it is well known that the recurrence rate after endoscopic decompression is also high . Emergency surgery is required only for patients in whom nonoperative treatment is unsuccessful or in those with peritonitis . Concerning this patient in particular, this was already his third episode, and perhaps, elective surgical excision of the redundant sigmoid may be the best management of this situation .