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

Abstract

BackgroundIntussusception 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 presentationA 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.ConclusionThe 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.

Transanal protrusion of intussusceptions in children

“…[1,10] Increased intestinal peristalsis may encourage rapid progression of the intussusceptum to the rectum [7] as seen with bowel inflammation following diarrhoea or respiratory From most previous studies, [2,5,6] it seems transanal protrusion is a manifestation of late presentation in ileocolic intussusceptions in childhood, but in the current study and from Ramachandran et al [7] some transanal protrusion occurred in those presenting within 48 h of onset of symptoms. It is likely that anatomical defects like nonfixation of ascending and descending colons predispose to transanal protrusion but delay in treatment allows time for transanal protrusion to occur.…”

“…[2,5] Likewise, most case reports of TAPIs occurred in female children [4] and adults. [1,10] These statistics are in contrast to childhood intussusceptions in general where males are usually more affected than females. [8,11,12] The reason for this is not readily known and intestinal malrotation, which is common in patients with TAPIs is not more common in females.…”

“…Transanal protrusion of intussusceptions (TAPIs) is a unique complication of intusssusception in children and usually occurs when the normally retroperitoneal ascending and descending colons are freely mobile being completely peritonealised with long mesenteries. [1,2] TAPI is an uncommon presentation of childhood intussusceptions and most publications on this topic are case reports [1,3,4] and case series [2,[5][6][7] from low and middle income countries of Africa and Asia.…”

Presentation, aetiology and treatment of adult intussusception in a tertiary Sub-Saharan Hospital: a 10-year retrospective study

“…• Necrosis/Gangrene: Y – present, N – absent.• Reduction: C – complete reduction done, P – partially reduced, N – no reduction attempted.• [18] and [25] indicate published references.…”

Laparoscopic high anterior resection for triple colorectal cancers with persistent ascending and descending mesocolons: A case report

“…Persistent mesocolon is a developmental anomaly characterized by the colonic mesentery's failure to fuse with the dorsal abdominal wall (1). Although some clinical complications of persistent mesocolon, such as primary intestinal obstruction, colonic volvulus, and intussusception (2)(3)(4), have been reported, this condition is asymptomatic in most cases (1). In patients with persistent ascending and descending mesocolons, the sigmoid colon is located under the ascending colon.…”