Retrograde intussusception through a loop ileostomy: a case report and review of the literature

Abstract

Intussusception through loop ileostomy is rare and must be treated without delay to avoid further complications. Retrograde intussusception is even rarer. We report a case of small bowel obstruction caused by retrograde intussusception through the distal limb of loop ileostomy in a male patient. A literature search is also carried out regarding this entity and published reports are discussed.Ann R Coll Surg Engl 2011; 93: e81-e82 doi 10.1308/147870811X590838Intussusception is the invagination of a portion of intestine into an adjacent segment in the manner of a telescope. Usually, this is in the direction of peristalsis but, unusually, it can occur in retrograde fashion against the normal flow of muscular contractions. Once started, intussusception can rapidly progress until the supplying blood vessels are drawn into the intussuscipiens (the portion of bowel containing the invagination) and become compressed with subsequent loss of blood supply to the intussusceptum (the part of the bowel that has telescoped in) and ischaemic with or without gangrene.Intussusception through a loop ileostomy is rare and must be treated without delay to prevent progression and further complications. Retrograde intussusception is even rarer and therefore less likely to be recognised early. We report a case of retrograde intussusception through the distal limb of a loop ileostomy in a male patient. A literature search is also carried out and published reports are discussed.Loop ileostomy was first described by Turnbull et al in 19711 and since then has become an important procedure in colorectal surgery for faecal diversion to treat a wide range of conditions including inflammatory bowel disease, trauma, radiation proctitis and benign and malignant conditions of the colon and rectum and pelvic organs.2 It can be fashioned and reversed with relative ease. A number of postoperative complications are reported including prolapse, parastomal hernia, retraction and obstruction. Intussusception has been reported on only five occasions. case historyWe report a 72-year-old male patient who underwent an elective low anterior resection with covering loop ileostomy for low rectal cancer. Histology confirmed an adenocarcinoma of the rectum (pT2 pN0). Postoperatively, the patient was commenced on free fluids, as tolerated, and a light diet was commenced on the second postoperative day. His stoma output was good on day two. On the third postoperative day he developed nausea and then vomited 900ml overnight.On examination of the stoma it was noted that the proximal limb lumen of the ileostomy was normal but that there was small bowel protruding through the site of the distal limb. Small bowel mucosa was evident rather than serosa, giving a high suspicion of intussusception rather than a prolapse as serosa would then have been visible. The protruding bowel was engorged and oedematous and a putative diagnosis of retrograde intussusception was made. Initially, reduction of the intussusception was attempted manually by applying gentle pressure ...

Intussusception through an ileostomy: A case report and literature review

“…The only diagnosis difficulty reported is related to the strangulated stomatal prolapse. In fact, the intussusception is commonly characterized by the replacement of the outermost layer “the serous” by the mucous membrane with its conniving valves [8]. Surgery remains the only possible treatment.…”

CT Features of Intussusception through an Ileostomy

“…Radiological examinations were not performed before surgery (3)(4)(5)(6)(7)(8)(9). In our case, preoperative CT was performed to evaluate the extent of ischemic bowel.…”

“…We found eight cases of intussusception through an ileostomy that have been reported in the literature, which are summarized in Table 1 ( [3][4][5][6][7][8][9]. In these cases, intussusception occurred through an end ileostomy or a loop ileostomy.…”

Intususcepción de muñón ileal, reporte de caso y revisión de la literatura

“…La invaginación del intestino usualmente es en dirección del peristaltismo, puede progresar rápidamente hacia los vasos sanguíneos que suministran al segmento que contiene la invaginación y se comprimen provocando isquemia con probabilidades de evolucionar a gangrena 10 .…”