Intussusception Causing Painless Hematochezia in an Adult

A 63-year-old woman was hospitalized after 2 episodes of mucoid, maroon-colored stools. She denied any prior or current episodes of abdominal pain, vomiting, fever, or recent travel. She was hemodynamically stable without significant drop in hematocrit. Colonoscopy revealed a 5-cm polypoid mass in the ascending colon with ulceration and fat eroding through the mucosa (Figure 1). The colonicsegment proximal to the mass could not be visualized on colonoscopy, but abdominal computed tomography (CT) showed a 5 x 3 x 4-cm fat density mass at the hepatic flexure causing colocolic intussusception of the ascending colon into the proximal transverse colon. Axial CT demonstrated the classical “target” sign and coronal view demonstrated a “sausage-shaped” mass (Figure 2). Initially, the patient refused surgical intervention but subsequently agreed, as she had recurrent rectal bleeding. On laparotomy, the ascending colonic segment was found gangrenous; therefore, a right hemicolectomy with ileocolic anastomosis was performed. Histolopathology confirmed a benign submucosal lipoma (Figure 3) and normal lymph nodes. Postoperatively the patient recovered well.