WAUGH’S SYNDROME: A RARE CASE OF ADULT COLO-COLONIC INTUSSUSCEPTION WITH MALROTATION IN A 61 YEAR-OLD MALE

ADB DRILON, MD, VC PORCIUNCULA II, MD
Institute of Digestive and Liver Diseases St. Luke’s Medical Center — Quezon CityMetro

Significance: The coexistence of gut malrotation and acute-onset intussusception is termed as Waugh syndrome. It is extremely rare in adults as most commonly presents in infants. We discuss the case of a male patient born with deformities of the extremities, diagnosed with malrotation with colo-colonic intussusception at a late age, and an ascending colon mass as a lead point.

Clinical Presentation: This is the case of a 61-year old male coming in due to a 1-week history of loose stools, cramping abdominal pain, and gradual abdominal enlargement which eventually led to difficulty passing of stool. Additional physical examination revealed macrodontia, long extremities with oligodactyly of the fingers and polydactyly of the foot suspicious for a syndromic presentation.

Management: Abdominal CT scan revealed a long segment intussusception from the level of the ano-rectal area, which also involved the sigmoid colonic segment, left colon and parts of the transverse colonic segments. The rest of the evaluable colon was air distended. Hence, a total colectomy, reduction of colo-colonic intussusception, end ileostomy was done. Histopathology revealed a Mucinous adenocarcinoma of the transverse colon as the lead point.

Recommendation: The diagnosis of intussusception with malrotation requires a high index of suspicion. As malrotation itself can predispose to intussusception, an additional presence of intraluminal pathology would increase its risk. This necessitates appropriate surgical intervention because of the high incidence of underlying bowel malignancy. A good quality contrast-enhanced CT scan of abdomen can help to diag3nose both these conditions and surgery remains the treatment of choice for managing these two conditions.

Keywords: case report, intussusception, malrotation, Waugh’s syndrome

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