Laparoscopic Treatment of Adult Sigmoidorectal Intussusception Caused by a Mucinous Adenocarcinoma of the Sigmoid Colon: A Case Report

Abstract

Intussusception is a rare cause of intestinal obstruction in adult patients, but is common in children. In fact, it accounts for an estimated 1% of all cases of bowel obstruction in adults, although adult intussusception of the large intestine is rare. Sigmoidorectal intussusception, however, is a rare variety with few cases reported in the literature. A mucinous adenocarcinoma, a subtype of adenocarcinoma, is characterized by extracellular mucin production and accounts for between 5% and 15% of the neoplasms of the colon and rectum. Despite the general consensus supporting surgical resections for adult intussuceptions, controversy remains over whether intussuceptions should be reduced before resection. Most cases of colon intussusception should not be reduced before resection because they most likely represent a primary adenocarcinoma. However, prior reduction followed by a resection can be considered for the sigmoidorectal intussusception to avoid inadvertent low rectal cancer sugery. We experienced one case of sigmoidorectal intussusception caused by a mucinous adenocarcinoma of the sigmoid colon in a 79-year-old woman. Abdominal computed tomography demonstrated a sigmoidorectal intussusception. After the end-to-end anastomosis-dilator-assisted reduction, the patient underwent a laparoscopic oncological anterior resection under the impression that a sigmoidorectal intussusception existed. We report a successful laparoscopic anterior resection in a patient with an intussusception caused by a sigmoid malignant tumor.

Laparoscopic reduction of sigmoidorectal intussusception by a modified Hutchinson’s maneuver: A case report

“…Park et al [4] used a lubricated sponge-on-the-stick to push up the distal end of the intussuscepted segment from the anus. Lee et al [5] inserted a dilator used for end-to-end anastomosis (EEA; 28 mm) through the anus to gently push the mass upward, while simultaneously attempting to reduce the intussusception using a laparoscopic grasper. In the present case, we performed a modi ed version of Hutchinson's maneuver, in which the rectum and mesorectum were completely mobilized to the level of the levator ani, and a laparoscopic gauze was used to wrap the lower rectum on the anal side of the lead point and then pulled to the oral side.…”

Strangulated appendiceal intussusception caused by isolated endometriosis

“…The most common causes are adenocarcinomas and lymphomas among malignant tumors and lipomas, leiomyomas, adenomatous polyps, and endometriosis among benign tumors. 1 AI is extremely rare, with reported rates of 0.01% in patients who undergo appendectomy. 2 AI secondary to endometriosis is also extremely rare, with less than 30 cases reported.…”

“…Adult colonic intussusception is caused by either malignant tumors (64%–87% cases) or benign tumors (29%–33%). The most common causes are adenocarcinomas and lymphomas among malignant tumors and lipomas, leiomyomas, adenomatous polyps, and endometriosis among benign tumors [ 1 ]. AI is extremely rare, with reported rates of 0.01% in patients who undergo appendectomy [ 2 ].…”

Laparoscopic management of sigmoidorectal intussusception caused by sigmoid carcinoma

“…There are couple of prior reports of successful reduction of sigmoidorectal intussusception by laparoscopic technique. [3,4] Sigmoidorectal intussusception can be successfully managed by laparoscopic technique and careful reduction of intussusception may avoid more radical procedures at this site. Dear Editor, Parathyroid carcinoma (PTC) accounts for <1% of primary hyperparathyroidism.…”

“…Dear Editor, Parathyroid carcinoma (PTC) accounts for <1% of primary hyperparathyroidism. [1][2][3] Differentiating carcinoma from adenoma is difficult in preoperative and intraoperative stages, and even after histopathological examination. Often, the diagnosis is made in retrospect.…”