Endoscopic carbon dioxide insufflation treating malignant colonic intussusception

Intussusception accounts for 1–5% of the causes of intestinal obstruction in adults.¹ Surgical resection is a radical treatment for malignant colonic intussusception.² However, emergent endoscopy for assessing colonic obstruction is sometimes needed preoperatively.³ Endoscopy can be used to temporally resolve intussusception preoperatively, although a detailed procedure has not been reported. This video reports the use of carbon dioxide (CO₂) insufflation via colonoscopy to repair intussusception due to colorectal cancer.

A 58-year-old man presented with severe abdominal pain and constipation. Computed tomography (CT) revealed a large mass and a three-layer structure of the sigmoid colon wall with the mesentery wrapped over the rectum, suggesting intussusception of the sigmoid colon (Fig. 1a). No signs of intestinal ischemia or perforation were observed. Colonoscopy was performed without bowel preparations, revealing a large mass overlapping the normal mucosa in the rectum (Fig. 1b). The colonoscope could not access the oral side of the lesion. Insufflation was achieved using CO₂ through the colonoscope. The mass was moved toward the oral side, and the overlapping sigmoid colon wall was gradually released. Type I advanced cancer of the sigmoid colon was observed after intussusception repair (Fig. 2a). Postcolonoscopy CT revealed that the mass moved to the sigmoid colon and the three-layer structure of the colonic wall disappeared (Fig. 2b). Three weeks after colonoscopy, a laparoscopic-assisted sigmoid colon resection was performed, and the final pathological diagnosis was well-differentiated adenocarcinoma of the sigmoid colon (T3, N0, M0, stage IIa) according to the Japanese Classification.⁴

Although colonic intussusception repair by air insufflation has been reported previously,⁵ this is the first report of a video of colonic intussusception repair using CO₂ insufflation using a colonoscope. This procedure is simple, inexpensive, and effective for avoiding emergency surgery. Therefore, CO₂ insufflation using colonoscopy may be an alternative option for repairing malignant colonic intussusceptions.

Author S.S. is an Associate Editor of Digestive Endoscopy. Author S.S. received a speaker honorarium from FUJIFILM Corporation. The other authors declare no conflict of interest for this article.