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Gastroenterology Grand Rounds May 1, 2014 Fellow: David Tang, M.D. Faculty: Milena Gould, M.D

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  • Gastroenterology Grand Rounds May 1, 2014 Fellow: David Tang, M.D. Faculty: Milena Gould, M.D.
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  • Case Presentation 61 year old White man Bloating and constipation alternating with diarrhea for 3 months. No weight loss No rectal bleeding 8/29/2012 Hgb8.3 MCV68 Ferritin2.60 FITPositive
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  • Colonoscopy 12/14/2012 Polyp at 40 cm
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  • Colonoscopy 12/14/2012 Mass at 45 cm
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  • Colonoscopy 12/14/2012 Mass at 45 cm
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  • Case Presentation Histology Polyp at 40 cm Tubulovillous adenoma Mass at 45 cm Invasive adenocarcinoma Staging CT scan showed mass in the descending colon and another large mass in the cecum.
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  • Case Presentation Patient refused referral to Medical Oncology until June 2013 He continued to suffer from intermittent abdominal pain, bloating, and diarrhea A repeat colonoscopy was performed to biopsy the cecal mass
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  • Colonoscopy 7/11/2013 Sigmoid Mass #1
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  • Colonoscopy 7/11/2013 Sigmoid Mass #2
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  • Colonoscopy 7/11/2013 Descending Colon Mass
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  • Colonoscopy 7/11/2013 Ascending Colon Mass vs Extrinsic Compression
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  • Case Presentation Four days after colonoscopy, patient presented to EC with constant severe abdominal camps and pain associated with nausea and vomiting
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  • Cecal mass Terminal Ileum Distal colon Everted cecal wall Courtesy of Dr. Zarrin-Khameh
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  • Diagnosis Intussusception of the cecum into the descending colon due to cecal adenocarinoma
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  • Clinical Questions What is the incidence of adult intussusception? What is the traditional understanding of the etiology of adult intussusception? How has CT changed our understanding of the etiology and natural history of adult intussusception? Is there a role for endoscopy to treat adult intussusception?
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  • Incidence of Adult Intussusception Cross-sectional study from Glasgow, UK estimated an annual incidence of 2 3 cases per 100,000 (