Hayato Shimoyama1,2, Kimihiko Ueno3,4, Masahiro Samizo3,5. 1. Department of Surgery, Kobe Rosai Hospital, 4-2-23 Kagoikedori, Chuouku, Kobe, Hyogo, 651-0053, Japan. hayatos@toranomon.gr.jp. 2. Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minatoku, Tokyo, 105-8470, Japan. hayatos@toranomon.gr.jp. 3. Department of Surgery, Kobe Rosai Hospital, 4-2-23 Kagoikedori, Chuouku, Kobe, Hyogo, 651-0053, Japan. 4. Department of Gastroenterological Surgery, National Hospital Organization Kobe Medical Center, 3-1-1, Nishiochiai, Sumaku, Kobe, Hyogo, 654-0155, Japan. 5. Department of Surgery, Sanda City Hospital, 3-1-1 Keyakidai, Sanda, Hyogo, 669-1321, Japan.
Abstract
BACKGROUND: Intussusception occurs when a segment of the bowel (the intussusceptum) telescopes into an adjacent segment (the intussuscipiens). Adult intussusception occurs rarely and often requires surgical resection for its treatment. We describe the case of an adult patient with extremely rare cecorectal intussusception treated using a novel combined transabdominal and trans-anal approach, which has not yet been reported in the literature. CASE PRESENTATION: A 71-year-old woman was transferred to our hospital for the treatment of upper abdominal pain. Physical examination, laboratory tests, and imaging inspections showed strangulated bowel obstruction induced by intussusception associated with the intra-rectal mass. We performed an emergency operation and treated the intussusception using a combined transabdominal and trans-anal approach. The intraoperative findings revealed bloody ascites and a potentially malignant tumor that had moved toward the anal side from peritoneal reflection. The tumor served as the lead point in the cecum with mobile cecum. After reducing the intussusception using the combined procedure, we removed the ileocecal portion. The intraoperative and histopathological findings suggested that cecum cancer with mobile cecum had caused the cecorectal intussusception. The patient had an uneventful postoperative course, except for postoperative pulmonary pneumonia. CONCLUSION: To the best of our knowledge, this is the first reported case of adult cecorectal intussusception due to cecum cancer with mobile cecum successfully treated using the combined transabdominal and trans-anal approach. This combined procedure may be useful in treating the intussusception where the lead point is distal from the peritoneal reflection.
BACKGROUND: Intussusception occurs when a segment of the bowel (the intussusceptum) telescopes into an adjacent segment (the intussuscipiens). Adult intussusception occurs rarely and often requires surgical resection for its treatment. We describe the case of an adult patient with extremely rare cecorectal intussusception treated using a novel combined transabdominal and trans-anal approach, which has not yet been reported in the literature. CASE PRESENTATION: A 71-year-old woman was transferred to our hospital for the treatment of upper abdominal pain. Physical examination, laboratory tests, and imaging inspections showed strangulated bowel obstruction induced by intussusception associated with the intra-rectal mass. We performed an emergency operation and treated the intussusception using a combined transabdominal and trans-anal approach. The intraoperative findings revealed bloody ascites and a potentially malignant tumor that had moved toward the anal side from peritoneal reflection. The tumor served as the lead point in the cecum with mobile cecum. After reducing the intussusception using the combined procedure, we removed the ileocecal portion. The intraoperative and histopathological findings suggested that cecum cancer with mobile cecum had caused the cecorectal intussusception. The patient had an uneventful postoperative course, except for postoperative pulmonary pneumonia. CONCLUSION: To the best of our knowledge, this is the first reported case of adult cecorectal intussusception due to cecum cancer with mobile cecum successfully treated using the combined transabdominal and trans-anal approach. This combined procedure may be useful in treating the intussusception where the lead point is distal from the peritoneal reflection.
Entities:
Keywords:
Cecorectal intussusception; Combined transabdominal and trans-anal procedure; Mobile cecum
Authors: M Lorenzi; A J Iroatulam; R Vernillo; T Banducci; S Mancini; A Tiribocchi; F S Ferrari; S Mancini Journal: Am Surg Date: 1999-01 Impact factor: 0.688