title: Caecal tumor biopsy with a rigid sigmoidoscope - Ileorectal intussusception.
abstract: BACKGROUND
  Ileorectal intussusception is a rare condition in adults in which the distal ileum, caecum, variable lengths of ascending and transvers colon, and associated mesentery invaginate into the rectum.
  
  
  METHODS
  We present the case of a 56 year old man who presented to our hospital for investigation of vague symptoms including small volumes of bright red rectal bleeding and colicky abdominal pain. He was found on CT scanning to have an extensive ileorectal intussusception and extensive liver metastasis. An emergency laparotomy was performed due to the concern of bowel ischaemia. No evidence of bowel ischaemia was found. The intussusceptum was carefully reduced and an extended right hemicolectomy with a primary anastomosis was performed. The patient recovered well and was discharged home six days post operatively.
  
  
  CONCLUSIONS
  Intussusceptions are rare in the adult population. They may not present with the classical triad of crampy abdominal pain, vomiting, and bloody stools and radiological imaging plays a key role in diagnosis. Intussusception in adults is usually secondary to malignancy and operative management needs to take into account the risk of upstaging the disease. In the face of pre-existing metastasis, preserving bowel length should be considered; however, there is no high level evidence to guide decision-making.
  
  
  CONCLUSIONS
  Intussusception is a diagnosis that needs to be considered in the adult population. Diagnosis largely depends on radiological imaging, especially CT scanning. The operative management is variable and should be determined on a case by case basis.
authors.affiliation: Department of Surgery, Flinders Medial Centre, Flinders Drive, Bedford Park, South Australia 5042 Australia. Electronic address: cameron.robertson@health.sa.gov.au.
authors.forename: Cameron G
authors.initials: CG
authors.lastname: Robertson
authors.affiliation: Department of Surgery, Flinders Medial Centre, Flinders Drive, Bedford Park, South Australia 5042 Australia. Electronic address: steven.due@health.sa.gov.au.
authors.forename: Steven L
authors.initials: SL
authors.lastname: Due
authors.affiliation: Department of Surgery, Flinders Medial Centre, Flinders Drive, Bedford Park, South Australia 5042 Australia. Electronic address: Kontoku@gmail.com.
authors.forename: Kontoku
authors.initials: K
authors.lastname: Shimokawa
authors.affiliation: Department of Surgery, Flinders Medial Centre, Flinders Drive, Bedford Park, South Australia 5042 Australia. Electronic address: marina.yeow@health.sa.gov.au.
authors.forename: Marina
authors.initials: M
authors.lastname: Yeow
keywords: Adult intussusception; Caecal tumour; Colorectal malignancy; Colorectal surgery; General surgery; Ileorectal intussusception