Precipitous intussusception with anal protrusion and complete overt rectal prolapse presenting with intestinal obstruction and an associated rectal adenoma in a young man: a case report

BMC Research Notes

Robert L Lukande¹  Peter A Ongom² 

[1] Histopathology Unit, Department of Pathology, School of Biomedical Sciences, Makerere College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda;Colorectal Surgery Unit, Department of Surgery, School of Medicine, Makerere College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda

关键词: Intestinal obstruction;    Anal protrusion;    Adenoma;    Complete overt rectal prolapse;    Intussusception;   

Others  :  1141436
DOI  :  10.1186/1756-0500-6-401

 received in 2012-10-30, accepted in 2013-10-02,  发布年份 2013

【 摘 要 】

Background

Intestinal obstruction secondary to intussusception, occurring simultaneously with complete rectal prolapse, is an unusual entity among young adults. When it occurs the intussusceptum may protrude per anus. Few cases are cited in literature; each with a unique clinical presentation. There is apparently no uniform trend in its clinical and pathological picture.

Case presentation

A 38-year-old, African-Ugandan man presented with sudden occurrence of rectal prolapse for one day. He had otherwise been in good health. Symptoms were precipitous. A clinical diagnosis of intussusception of the lower gut with rectal prolapse, and intestinal obstruction, was made. The intussusception was found to have a polyp as the ‘lead point’. He was treated by manual reduction of the intussusception and the prolapse under general anesthesia. Histopathologic examination of the polyp showed it to be an adenoma. Definitive surgical treatment of the patient was not completed due to socioeconomic challenges.

Conclusions

Rectal prolapse and intussusception are commonly childhood conditions. Rectal prolapse alone is commoner in the middle-aged and elderly; females in particular. The finding of this combined clinical entity in a young, adult male is therefore a unique condition with an unusual presentation. It is the first case of its kind reported in East Africa. It is also an example of an adenoma constituting a ‘lead point’ for an intussusception at the gastrointestinal tract’s terminus. Even in the presence of a pre-existing adenoma, a relatively common lesion, other differential diagnoses acting as ‘lead points’ ought to be considered in perspective. This characteristic, along with other features described in this case, is useful knowledge for colorectal surgeons, general surgeons, gastrointestinal pathologists, and gastroenterologists given their involvement in the diagnosis and management of anorectal disease of peculiar presentation.

【 授权许可】

   
2013 Ongom and Lukande; licensee BioMed Central Ltd.

【 图 表 】

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