Naoya Kimura1, Masatsugu Hiraki2, Hirofumi Sato1, Hiroki Koga1, Daisuke Mori3, Toshiya Tanaka1, Kenji Kitahara1. 1. Department of Surgery, Saga Medical Center Koseikan, 400 Nakabaru, Kasemachi, Saga City, Saga 840-8571, Japan. 2. Department of Surgery, Saga Medical Center Koseikan, 400 Nakabaru, Kasemachi, Saga City, Saga 840-8571, Japan. Electronic address: masatsuguhiraki@hotmail.com. 3. Department of Pathology, Saga Medical Center Koseikan, 400 Nakabaru, Kasemachi, Saga City, Saga 840-8571, Japan.
Abstract
INTRODUCTION AND IMPORTANCE: Intussusception of the cecum due to acute appendicitis is rare condition. PRESENTATION OF CASE: A 17-year-old male patient presented to our hospital with a chief complaint of right lower abdominal pain, which had lasted for two days. Computed tomography (CT) revealed a "target sign" from the cecum to the ascending colon, leading to a diagnosis of cecocolic intussusception. Colonoscopy revealed an erythematous, edematous, and internally distorted cecum in the ascending colon, which was difficult to repair with air insufflation. Laparoscopic surgery was performed to remove the bowel obstruction. Repositioning of the invaginated cecum was difficult due to the presence of a hard and edematous colic wall. Therefore, laparoscopic ileocecal resection was performed to release the obstruction. The pathological diagnosis was appendicitis and abscess within the cecum wall, with no malignant findings. DISCUSSION: In our case, intussusception was considered to have caused thickening of the intestinal wall of the cecum due to inflammation of the appendix, and the thickened area became the leading point. CONCLUSION: Considering that malignancy is a frequent leading point in adult patients with intussusception, a preoperative endoscopic examination is important for minimizing bowel resection.
INTRODUCTION AND IMPORTANCE: Intussusception of the cecum due to acute appendicitis is rare condition. PRESENTATION OF CASE: A 17-year-old male patient presented to our hospital with a chief complaint of right lower abdominal pain, which had lasted for two days. Computed tomography (CT) revealed a "target sign" from the cecum to the ascending colon, leading to a diagnosis of cecocolic intussusception. Colonoscopy revealed an erythematous, edematous, and internally distorted cecum in the ascending colon, which was difficult to repair with air insufflation. Laparoscopic surgery was performed to remove the bowel obstruction. Repositioning of the invaginated cecum was difficult due to the presence of a hard and edematous colic wall. Therefore, laparoscopic ileocecal resection was performed to release the obstruction. The pathological diagnosis was appendicitis and abscess within the cecum wall, with no malignant findings. DISCUSSION: In our case, intussusception was considered to have caused thickening of the intestinal wall of the cecum due to inflammation of the appendix, and the thickened area became the leading point. CONCLUSION: Considering that malignancy is a frequent leading point in adult patients with intussusception, a preoperative endoscopic examination is important for minimizing bowel resection.
Authors: Young H Kim; Michael A Blake; Mukesh G Harisinghani; Krystal Archer-Arroyo; Peter F Hahn; Martha B Pitman; Peter R Mueller Journal: Radiographics Date: 2006 May-Jun Impact factor: 5.333