Anal protrusion of an ileo-colic intussusception in an adult with persistent ascending and descending mesocolons: a case report

BMC Research Notes

Josephat Jombwe²  Robert L Lukande³  Peter A Ongom¹ 

[1] Colorectal Surgery Unit, Department of Surgery, School of Medicine, Makerere College of Health Sciences, Makerere University, P O Box 7072, Kampala, Uganda;Colorectal Surgery Unit, Department of Surgery, Mulago Hospital, P O Box 7051, Kampala, Uganda;Histopathology Unit, Department of Pathology, School of Biomedical Sciences, Makerere College of Health Sciences, Makerere University, P O Box 7072, Kampala, Uganda

关键词: Zygosis;    Azygosis;    Persistent mesocolon;    Anal protrusion;    Ileo-colic intussusception;   

Others  :  1144863
DOI  :  10.1186/1756-0500-6-42

 received in 2013-01-03, accepted in 2013-01-30,  发布年份 2013

【 摘 要 】

Background

Intussusception is one of the less common causes of intestinal obstruction among adults. It is usually covert (concealed) in its clinical presentation. The ileo-colic type with accompanying anal protrusion is extremely rare. The case at hand is that of both an ileo-colic intussusception with anal protrusion, in the presence of a persistence of both the ascending and descending mesocolons; a case possibly yet to be documented in literature.

Case presentation

A 32 year-old African-Ugandan woman presented with complaints of a mass protruding per anus for 2 weeks. It was reducible and associated with colicky abdominal pain, loose stools, and bloody-mucoid discharge per anus. She had previously had a one and a half month’s history of abdominal pain; periodically continuous, while other times colicky in character. Examination and investigations revealed an intussusception with a partial intestinal obstruction. At laparotomy she was found to have an ileo-colic intussusception with a freely mobile colon throughout its length. There were persistent ascending and descending mesocolons, and absent hepatocolic and splenocolic ligaments. The intussusceptum was ‘milked’ but not completely reducible. A right hemicolectomy was done, with ileo-transverse colonic anastomosis. Histopathological examination revealed no preexisting pathologic lesion as a lead point.

Conclusion

The persistence of the ascending and descending mesocolons (azygosis) best explains the anal protrusion of an ileo-colic intussusception with partial obstruction. In this case zygosis (normal retroperitoneal ascending and descending colonic positioning) failed embryologically. This experience is particularly beneficial to general surgeons, radiologists, gastroenterologists, colorectal surgeons and pathologists.

【 授权许可】

   
2013 Ongom et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

Figure 5.

【 参考文献 】

• [1]Azar T, Berger DL: Adult intussusception. Ann Surg 1997, 226:134-138.
• [2]Chen R, Zhao H, Sang X, Mao Y, Lu X, Yang Y: Severe adult ileosigmoid intussusception prolapsing from the rectum: a case report. Cases Journal 2008, 1:198. BioMed Central Full Text
• [3]Hall JH, Bradfield WJ: Prolapse of the ileum through the rectum and anal canal. Br J Surg 1972, 59(2):149-151.
• [4]Ioakinis KD: [Invagination of a mobile cecum with prolapse through the anus]. Vestn Khir Im I I Grek 1968, 101(12):108-109.
• [5]Ameh EA, Mshelbwala PM: Transanal protrusion of intussusception in infants is associated with high morbidity and mortality. Ann Trop Paediatr 2008, 28(4):287-292.
• [6]David AW, Stephen E, Pradhan NR, Nayak S, Perakath B: Adult idiopathic ileosigmoid intussusception prolapsing per rectum. Indian J Gastrol 2007, 26(1):39-40.
• [7]Ellis H: The gastrointestinal tract. In Clinical Anatomy for Students and Junior Doctors. 11th edition. Edited by Sugden M. Massecusetts: Blackwell publishing; 2006:91.
• [8]Moore KL: The Abdomen. In Clinically oriented anatomy. 3rd edition. Edited by Satterfield TS. Williams and Wilkins, Baltimore; 1992:205-207.
• [9]Ogihara M, Kawamura YJ, Minami M, Watanabe T, Sunami E, Matsuda K, et al.: Primary intestinal obstruction complicated by persistent descending mesocolon. Int Surg 2000, 85(3):226-230.
• [10]Chen A, Yang FS, Shih SL, Sheu CY: CT diagnosis of volvulus of the descending colon with persistent mesocolon: a case report. Am J Roentgenol 2003, 180(4):1003-1006.
• [11]Kanai M, Tokunaga T, Miyaji T, Mataki N, Okada C, Mitani K, et al.: Colonic varices as a result of persistent mesocolon of the ascending and descending colon. UCTN 2011, 43(Suppl 2):103-104.
• [12]Reijnen HA, Joosten HJ, de Boer HH: Diagnosis and treatment of adult intussusception. Am J Surg 1989, 158(1):25-28.
• [13]Begos DG, Sandor A, Modlin IM: The diagnosis and management of adult intussusception. Am J Surg 1997, 173(2):88-94.
• [14]Rasaretnam R, Kumarakulasinghe CB, Eaton HL: Tropical intussusception in adults. Aust N Z J Surg 1976, 46(1):57-63.
• [15]Rathore MA, Andrabi SI, Mansha M: Adult intussusception – a surgical dilemma. J Ayub Med Coll Abbottabad 2006, 18:3-6.