Recommended Citation
Stevenson JR, Momin A, Huq N. When Polyps Strike Back: Adult Intussusceptions in Suspected Familial Adenomatous Polyposis. Poster presented at: American College of Gastroenterology (ACG) 2026 Annual Scientific Meeting; October 11, 2026; Nashville, TN. Poster P0416.
Presentation Notes
Poster presented at: American College of Gastroenterology (ACG) 2026 Annual Scientific Meeting; October 11, 2026; Nashville, TN. Poster P0416.
Abstract
Introduction: Hereditary polyposis syndromes present with anemia, rectal bleeding, or polyps found on screening, rather than bowel obstruction. Adult intussusception is uncommon and rarely heralds these syndromes. We report an unusual presentation of suspected adenomatous polyposis in a young adult without a significant family history who developed two distinct intussusceptions in rapid succession, first in the jejunum and then in the distal colon. Case Description/Methods: A 24-year-old man with intermittent hematochezia, fatigue, weight loss, and no significant family history was admitted with profound anemia (hemoglobin 4.8 g/dL), treated with blood transfusions and intravenous iron. Computed tomography (CT) demonstrated a short-segment jejunal intussusception without obstruction. Colonoscopy revealed innumerable sessile and pedunculated polyps. More than 20 polyps were removed from cecum and rectum; pathology showed tubular adenomas, raising concern for an adenomatous polyposis syndrome. He was discharged with genetic referral. Four days later, he returned with epigastric pain, nausea, coffee-ground emesis, and recurrent hematochezia. Repeat CT showed a 12-cm distal colonic intussusception with proximal distension and no free air. Surgery and gastroenterology were consulted; fluoroscopic watersoluble contrast enema reduced the intussusception with rapid symptom improvement, avoiding emergent colectomy. Interval colonoscopy at two months showed persistent large tubular and tubulovillous adenomas. Additional large pedunculated lead-point polyps were removed. He is now undergoing genetic and colectomy evaluation. Discussion: This case illustrates an unusual presentation of diffuse colonic polyposis with sequential smallbowel and distal colonic intussusceptions in a young adult with severe iron-deficiency anemia. The extensive adenoma burden likely created multiple lead points for recurrent intussusception. In this hemodynamically stable young patient without peritoneal signs and with recent colonoscopy demonstrating diffuse benign-appearing adenomas, nonoperative reduction avoided emergent colectomy and enabled germline testing and planned prophylactic surgery. Hereditary polyposis syndromes should be considered in young adults with anemia, hematochezia, and intussusception, even without a suggestive family history. AI use disclosure: Generative AI tools assisted with literature review and language editing. No patient-identifiable information was entered, and the authors verified the final content. Figure 1. Contrast-enhanced CT of the abdomen and pelvis from the second admission showing a target-like soft tissue mass in the distal colon (yellow circle), consistent with colonic intussusception. Figure 2. Interval colonoscopy showing numerous large pedunculated adenomas, consistent with an underlying adenomatous polyposis syndrome.
Type
Poster
Affiliations
Aurora Health Care