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Colo-colonic intussusception caused by a solitary Peutz-Jeghers polyp

Department of Radiology, 2nd Floor, University of Alberta Hospital, 8440 112 Street, Edmonton, Alberta, Canada, T6G 2B7

View larger version (135K): [in a new window]   Figure 1. Initial radiograph demonstrates distended ascending and transverse colon, with a rounded soft tissue density in the proximal descending colon.

View larger version (55K): [in a new window]   Figure 2. (a) Lateral fluoroscopic spot view of a single-contrast enema shows a tortuous filling defect in the descending colon (arrow) with a thin rim of contrast passing upwards anteriorly. (b) Anteroposterior fluoroscopic spot view reveals thin crescents of contrast with a "whirled" appearance in the descending colon (arrow) with a normal appearing splenic flexure above.

View larger version (38K): [in a new window]   Figure 3. (a) Axial CT image augmented with intravenous contrast near the splenic flexure shows a "target" shape of colon within colon, with entrapped mesentery (thick arrow). A rim of contrast from the recent enema is also seen (thin arrow). (b) Axial CT image near the distal tip of the intussusceptum shows wall thickening and oedema (arrow).

View larger version (122K): [in a new window]   Figure 4. Gross pathology specimen shows typical appearance of a Peutz-Jeghers polyp at the lead point (arrow).