A case of inside-out type intussuscepted appendix

Abstract

A 44-year-old woman came to our hospital because of transient hematochezia in February 2000. She had no particular past history. Total colonoscopy showed multiple scars and pseudopolyps from the cecum to the transverse colon, the ileo-cecal valve showed deformity and the appendix was completely deviated into the lumen. Endoscopically, the diagnosis of old tuberculosis of the intestine and intussusception of the appendix was made. Since, neither diagnosis was likely to be the cause of hematochezia, she was observed without treatment. She remained asymptomatic, and colonoscopy performed in December 2000 and January 2003 showed no remarkable change. Intussusception of the appendix is a rare disease with only about 200 reports in the world. Most patients appear with acute abdominal pain mimicking appendicitis or intussusception of the intestine, or suffer from chronic abdominal pain, whereas there are cases which are incidentally diagnosed from barium enema or colonoscopy as in this case. The presence of both abnormal peristalsis and abnormal anatomy of the appendix is considered to be the cause. Intussusception of the appendix is classified into 5 types according to the grade of intussusception by Langsam. This case was diagnosed as inside-out type. Though the cause was unknown for this case, old tuberculosis of the intestine might have played a role in its pathogenesis.