Ascending Colon Adenocarcinoma Presenting as Intussusception and Treated with Robotic Right Hemicolectomy

Introduction: Colonic intussusception is a rare form of bowel obstruction in which a segment of the colon telescopes into the adjacent distal portion of the bowel.1 This condition may resolve and recur, or it may lead to a complete obstruction, necrosis of the bowel, and additional complications if untreated. Causes of colonic intussusception in adults include benign polyps, lipomas, lymphoid hyperplasia, or malignant tumors.2 This video depicts a colonic intussusception and a robotic resection entailing a right hemicolectomy to treat the underlying etiology. Methods: A 42-year-old woman presented with an episode of constipation and crampy abdominal pain. A computed tomography scan revealed right-sided colonic intussusception that spontaneously reduced after initial presentation. Imaging did not reveal any other pathology or evidence of metastatic malignant disease. Subsequent evaluation included a diagnostic colonoscopy, which revealed a large polypoid mass in her ascending colon. Superficial biopsies revealed adenoma but no invasive malignancy. Based on her presentation, lesion size, and concern for cancer, she was encouraged to undergo surgical resection. Shortly after her expedited work-up, a robotic right colectomy with intracorporeal anastomosis was performed. The key steps in the operation are highlighted, including division of the ileocolic pedicle, medial-to-lateral dissection, transection of the bowel, and an intracorporeal isoperistaltic anastomosis. Results: The patient recovered well and uneventfully after surgery, and was discharged home on postoperative day three. Final pathology analysis revealed a 4 cm colonic adenocarcinoma invading the submucosa (T1 lesion) with negative margins and 28 lymph nodes, all negative for metastatic disease (AJCC stage I). Conclusions: Colonic intussusception is concerning for cancer when this condition presents in adult patients and may be treated using a robotic approach to provide a shorter postoperative length of stay and greater lymph node harvest as compared with a traditional laparoscopic right colectomy.3 As the video demonstrates, this condition can be treated safely using a minimally invasive robotic surgical approach. No competing financial interests exist. Runtime of video: 8 mins 37 secs Patient Consent: Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure.