Total ileocolic intussusception with rectal prolapse presenting in an adult: a case report and review of the literature

World Journal of Emergency Surgery

Yoram Kluger¹  Offir Ben-Ishay¹  James Frydman¹ 

[1] Department of General Surgery, Rambam Health Care Campus, POB 9602, Haifa 31096, Israel

关键词: Zygosis;    Rectal prolapse;    Adult intussusception;   

Others  :  791666
DOI  :  10.1186/1749-7922-8-37

 received in 2013-05-05, accepted in 2013-09-15,  发布年份 2013

【 摘 要 】

Introduction

Intussusception is rarely encountered in adults, accounting for just 5% of all occurrences and 1% of bowel obstructions. In up to 90% of episodes of adult intussusceptions, operative intervention is required secondary to pathological lead points. Prior to the current report, only three cases of total ileocolic intussusception with rectal prolapse in adults have been described in the world literature, making it an important contribution to surgical knowledge. In addition to a discussion of disease etiology, this review outlines sound diagnostic and therapeutic principles in the successful management of this rare emergent surgical condition.

Case presentation and literature review

In this case report, we will present a rare case of total ileocolic intussusception with rectal prolapse in a 22 year-old female without antecedent history. She had both a lead point in the cecum, as well as a highly mobile, intraperitoneal colon. Lead points have been found in only half of the reported cases, including this one. In addition, colonic laxity may enable this phenomenon, being attributed to the loss of zygosis during the embryological period, in which there is persistence of the ascending and descending mesocolons and lack of apposition to the retroperitoneum. The diagnostic work-up, operative strategy and pathological findings are discussed. The three previous cases reported in the English-language medical literature were reviewed.

Conclusions

Adult intussusception, while uncommon, may be encountered in an acute surgical setting and optimal outcomes depend on a high index of suspicion and expeditious management. Embryological divergence may contribute to the even rarer variant of total ileocolic intussusception with rectal prolapse.

【 授权许可】

   
2013 Frydman et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

【 参考文献 】

• [1]Azar T, Berger DL: Adult intussusception. Ann Surg 1997, 226(2):134-138.
• [2]Marinis A, Yiallourou A, Samanides L, et al.: Intussusception of the bowel in adults: A review. World J Gastroenterol 2009, 15(4):407-411.
• [3]Ongom PA, Lukande RL, Jombwe J: Anal protrusion of an ileo-colic intussusception in an adult with persistent ascending and descending mesocolons: a case report. BMC Res Notes 2013, 6:42. BioMed Central Full Text
• [4]Chen R, Zhao H, Sang X, Mao Y, Lu X, Yang Y: Severe adult ileosigmoid intussusception prolapsing from the rectum: a case report. Cases J 2008, 1:198. BioMed Central Full Text
• [5]David AW, Stephen E, Pradhan NR, Nayak S, Perakath B: Adult idiopathic ileosigmoid intussusception prolapsing per rectum. Indian J Gastoenterol 2007, 26(1):39-40.
• [6]Gayer G, Zissin R, Apter S, Papa M, Hertz M: Adult intussusception – a CT diagnosis. Br J Radiol. 2002, 75:185-190.
• [7]Begos DG, Sandor A, Modlin IM: The diagnosis and management of adult intussusception. Am J Surg 1997, 173:88-94.
• [8]Chen A, Yang FS, Shih SL, Sheu CY: Case report. Ct diagnosis of volvulus of the descending colong with persistent mesocolon. AJR Am J Roentgenol 2003, 180(4):1003-6.
• [9]Vyas KC, Joshi CP, Misra S: Volvulus of descending colon with anamolous mesocolon. Indian J Gastroenterol 1997, 16(1):34-35.
• [10]Liew KL, Choong CS, Shiau GF, Yang WC, Su CM: Descending mesocolon defect herniation: case report. Changgeng Yi Xue Za Zhi 1999, 22:133-137.