The 'wandering' abdominal lump: intussusception up to splenic flexure of an ileocaecal adenocarcinoma

A63-year old woman presented with a 4-day history of watery diarrhoea that was preceded by acute constipation. This was associated with intermittent colicky abdominal pain and one episode of fresh rectal bleeding on the previous day. Past history included haemorrhoids, cholecystectomy and reflux disease with no significant family history of cancer. She was seen in the accident and emergency department with a mass in right iliac fossa (RIF), which was managed as scabylous mass owing to the history of constipation. The next day, the woman came back with continued symptoms. On this occasion, she had a firm, mobile mass, now palpable in the left hypochondrium associated with abdominal distension. Rectal examination revealed an empty rectum. Haematological and biochemical tests including tumour markers were essentially normal. Plain X-ray of the abdomen revealed a partial small bowel obstruction and the patient was commenced on conservative management. The following day, although her symptoms resolved, the mob...