Successful treatment of adult cecorectal intussusception caused by cecum cancer with mobile cecum: a case report

Abstract

Background Intussusception occurs when a segment of the bowel (the intussusceptum) telescopes into an adjacent segment (the intussuscipiens). Adult intussusception occurs rarely and often requires surgical resection for its treatment. We describe the case of an adult patient with extremely rare cecorectal intussusception treated using a novel combined transabdominal and trans-anal approach, which has not yet been reported in the literature. Case presentation A 71-year-old woman was transferred to our hospital for the treatment of upper abdominal pain. Physical examination, laboratory tests, and imaging inspections showed strangulated bowel obstruction induced by intussusception associated with the intra-rectal mass. We performed an emergency operation and treated the intussusception using a combined transabdominal and trans-anal approach. The intraoperative findings revealed bloody ascites and a potentially malignant tumor that had moved toward the anal side from peritoneal reflection. The tumor served as the lead point in the cecum with mobile cecum. After reducing the intussusception using the combined procedure, we removed the ileocecal portion. The intraoperative and histopathological findings suggested that cecum cancer with mobile cecum had caused the cecorectal intussusception. The patient had an uneventful postoperative course, except for postoperative pulmonary pneumonia. Conclusion To the best of our knowledge, this is the first reported case of adult cecorectal intussusception due to cecum cancer with mobile cecum successfully treated using the combined transabdominal and trans-anal approach. This combined procedure may be useful in treating the intussusception where the lead point is distal from the peritoneal reflection.

Mucinous tumor of transverse colon presenting with colo-colic intussusception in a 24-year old female: Aggressive tumor with a rare presentation in a young female

“…Intussusception is defined as telescoping of a proximal bowel loop (known as the intussusceptum) into an immediately adjacent distal bowel loop (known as the intussuscipiens) [1,[3][4][5][6]8,[10][11][12]. It is an uncommon type of bowel obstruction which usually results from a disturbance in the normal peristalsis secondary to pathology in the wall of the intestine [1,5,8,11].…”

“…AI can affect any part of the bowel; however, it is more common in the small bowel and affects the colon in only 20-25% [2,7,8,11-13]. In adults, the colonic intussusception is commonly seen in the sigmoid colon, transverse colon, and the cecum [6]. Approximately 90% of the cases of intussusception in the pediatric population are idiopathic; however, 90% cases of Adult Intussusception (AI) are secondary to a well-known pathological lead point and only 5% of the large bowel and 16% of the small bowel intussusceptions are idiopathic [1,2,4,5,11].…”

“…Intussusception is the most common cause of bowel obstruction in the pediatric population [1][2][3][4][5]. Intussusception is rare in adults with an estimated incidence of 2 cases/1,000,000 population/year, accounting for only 5% of all intussusceptions, 1% of all bowel obstructions, and 0.003-0.02% of all hospital admissions [2][3][4][5][6][7][8][9]. Amongst the Adult Intussusceptions (AI), 38-44% occur in the colon and 52-55% in the small intestine [4,6].…”

“…Intussusception is rare in adults with an estimated incidence of 2 cases/1,000,000 population/year, accounting for only 5% of all intussusceptions, 1% of all bowel obstructions, and 0.003-0.02% of all hospital admissions [2][3][4][5][6][7][8][9]. Amongst the Adult Intussusceptions (AI), 38-44% occur in the colon and 52-55% in the small intestine [4,6]. AI has various clinical presentations when compared to the pediatric form [8,10].…”

“…90% of the AI patients harbor a pathological lead point which is in contrast to the intussusception in the pediatric age group, where approximately 90% of the cases are idiopathic, often influenced by anatomic or infection related factors [1,2,4,5,8,10,11]. In the pediatric population, non-surgical management such as pneumatic or hydrostatic reduction is sufficient in 80% of the patients whereas surgery, often with bowel resection, is the recommended treatment for majority of the patients with AI, although the optimal surgery remains controversial [1,5,6,8,10,11]. In AI, the early and correct diagnosis of the etiology and timely treatment are very important; however, most patients are diagnosed late as a result of a poor index of suspicion and misdiagnosis [2,3].…”